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 program 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 an computer decision support system to assist nursing home 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. 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

Publications

Connor SR, Tecca M, LundPerson J, Teno JM. Measuring Hospice Care: The National Hospice and Palliative Care Organization National Hospice Dataset. Journal of Pain and Symptom Management. October 4, 2004; 28(4):316-28.

Baier RR, Gifford DR, Patry G, Banks SM, Rochon T, DeSilva D, Teno JM. Ameliorating pain management in nursing homes: A collaborative quality improvement project. Journal of the American Geriatrics Society. December 2004; 52(12):1988-95.

Mitchell SL, Teno JM, Miller SC, Mor V. A national study of the location of death for older persons with dementia. Journal of the American Geriatrics Society. February 2005; 53(2):299-305.

Johnson VMP, Teno JM, Bourbonniere M, Mor V. Palliative Care Needs of Cancer Patients in U.S. Nursing Homes. Journal of Palliative Medicine. April 2005; 8(2):273-79.

Teno JM, Rochon T. Rules to use and rules to lose for pain management in the long-term care setting. Medical and Health, Rhode Island. April 2005; 88(4):110-4.

Connor SR, Teno J, Spence C, Smith N. Family Evaluation of Hospice Care: Results from Voluntary Submission of Data Via Website. Journal of Pain and Symptom Management. July 2005; 30(1):9-17.

Mor V, Zinn J, Angelelli J, Teno JM, Miller SC. Driven to Tiers: Socioeconomic and Racial Disparities in the Quality of Nursing Home Care. The Milbank Quarterly. 2004; 82(2):227-56.

Teno JM. Advance Directives: Time to Move On (Editorial). Annals of Internal Medicine. July 20, 2004; 141(2):159-60.

Goodlin SJ, Hauptman PJ, Arnold R, Grady K, Hershberger RE, Kutner J, Masoudi F, Spertus J, Dracup K, Cleary JF, Medak R, Crispell K, Piña I, Stuart B, Whitney C, Rector T, Teno J, Renlund DG. Consensus Statement: Palliative and Supportive Care in Advanced Heart Failure. Journal of Cardiac Failure. June 3, 2004; 10(3):200-9.

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. Journal of the American Geriatrics Society. May 2004; 52(5):762-7.

Ward NS, Teno J. A death worth dying for (Editorial). Medical Care. May 2004; 42(5):406-7.

Teno JM, Mor V, Welch LC, Wetle T, Shield R, Casey V, Clarridge BR. Memories of Loved Ones About Care at the End of Life (In Reply). Journal of the American Medical Association. March 24/31, 2004; 291(12):1446.

Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Shield R, Mor V. Family Perspectives on End-of-Life Care at the Last Place of Care. Journal of the American Medical Association. January 2, 2004 291(1): 88-93.

Mitchell SL, Teno JM, Roy J, Kabumoto G, Mor V. Clinical and Organizational Factors Associated with Feeding Tube Use Among Nursing Home Residents With Advanced Cognitive Impairment. Journal of the American Medical Association. July 2, 2003; 290(1): 73-80.

Teno JM, Lynn J, Wenger NS, Phillips RS, Murphy DP, Connors AF, et. al. (1997): Advance directives for seriously ill hospitalized patients: Effectiveness with the Patient Self-Determination ACT and the SUPPORT Intervention. Journal of the American Geriatrics Society, 45:500-507.

Teno JM, Landrum K, Lynn J. (1997): Defining and measuring outcomes in end-stage dementia. Alzheimer Disease and Associated Disorders, 11. Suppl. 6:25-29.

Teno JM, Branco KJ, Mor V, Phillips CD, Hawes C, Morris J, et. al. (1997): Changes in advance care planning in nursing homes before and after the Patient Self-Determination ACT: Report of a 10-state survey. Journal of the American Geriatrics Society, 45:939-944.

Hofmann JC, Wenger NS, Davis RB, Teno JM, Connors AF, Desbiens N, et. al., for the SUPPORT Investigators. (1997): Patient preferences for communication with physicians about end-of-life decisions. Annals of Internal Medicine, 127(1):1-12.