# PATTERNS OF DECLINE IN NURSING HOME PATIENTS

> **NIH NIH R01** · BROWN UNIVERSITY · 1992 · $31,999

## Abstract

The rapid growth in number of the oldest old has created pressures to
expand U.S. nursing home capacity.  Concerns about the quality of nursing
home care, crystalized in the 1986 Institute of Medicine report, have
prompted regulators and researchers to consider judging nursing home
quality on the basis of the outcomes achieved by the residents' experience.
Since functioning is increasingly seen as the meaningful indicator of
nursing home residents' quality of life, the observed rate of functional
decline or stability manifested by nursing home residents is now considered
to be a central measure of outcome.

The purpose of this project is to examine conceptual and technical issues
involved in modelling the passage of nursing home residents through a
sequence of functional states, death, hospital transfer or return to the
community.  We believe successful modelling of the phenomenon of functional
change in this population will provide the basis for evaluating meaningful
outcome oriented quality assurance indicators such as functional decline.

Using an extensive longitudinal patient data base drawn from multiple
panels of new, admissions to nursing homes owned or managed by the National
Health Corporation, we will examine the medical and diagnostic as well as
the social and behavioural factors that affect nursing home residents'
chance of transition between levels of physical function, to death, to
hospital and to the community.  In this process we will study the
statistical problems that arise in fitting stochastic process models to
observations of those transitions.  We will develop model based indicators
of the quality of nursing home care that can be used to predict the future
functional states of residents with various combinations of relevant
medical and social covariates.  Study results will include improvements in
the methods of estimation of the probabilities of ADL transition, the
expected duration of stay in each level, and the expected length of stay in
the nursing home prior to discharge or death.

## Key facts

- **NIH application ID:** 3120454
- **Project number:** 1R01AG008717-01A2
- **Recipient organization:** BROWN UNIVERSITY
- **SAM.gov UEI:** E3FDXZ6TBHW3
- **Principal Investigator:** WALTER FREIBERGER
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 1992
- **Award amount:** $31,999
- **Award type:** 1
- **Project period:** 1992-09-01 → 1994-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/3120454

## Citation

> US National Institutes of Health, RePORTER application 3120454, PATTERNS OF DECLINE IN NURSING HOME PATIENTS (1R01AG008717-01A2). Retrieved via MORVS 2026-10-25 from https://api.morvs.ai/grant/nih/3120454. Licensed CC0.

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