Vol XVIII, Sep `05

McNabney: My interest dates back to my fellowship at UCLA where I worked closely with Dan Osterweil and Joseph Ouslander at the Jewish Homes. I was very impressed with their work in this area. I came to Johns Hopkins in 1998 and became medical director to two facilities in 1999. I started two small research projects in these facilities. Around that time, I heard about the AMDA Foundation Research Network, and I knew I wanted to get involved.

Foundation: What kinds of studies have you been involved in?

McNabney: The two studies I had published outside of my Research Network activities involved communication and optimizing care as coordinated by telephone conversations with physicians. Within the Network, my specific project involved a survey study regarding nursing home physicians and their management of diabetes in this setting. We thought it would be interesting to examine and describe the lay of the land on this topic--including physician attitudes and treatment preferences. We believe that physicians' approach to diabetes in long term care has important implications for patient care as well as perceived compliance with regulations.

We proposed a study to look not just at what physicians do but how they vary their practice. This has been an interesting and revealing study, and we learned that physicians do vary their practice because--instead of relying on protocols or guidelines--they step back and look at individual patients.

Foundation: What do you hope to accomplish with your research?

McNabney: Given that there is a huge population of people living in nursing facilities and that the acuity of these individuals is rising, long term care research will provide information to help guide care and decision-making. It also will add evidence-based information to the process that nursing facility care has lacked in the past. The Research Network is contributing to this evidence-based approach and offers a broad perspective on what nursing facility physicians are doing and thinking and what interventions work best in various situations.

Foundation: What are some of the greatest challenges you have faced in conducting your research?

McNabney: The studies I have done have been small scale, and I've worked with a single IRB. I think multi-site studies where multiple IRB approval is necessary present a barrier and a real challenge to overcome. While it always will be a challenge to coordinate multiple sites, this work ultimately will pay off; and such studies will result in providing lots of information about different demographics and options within long term care.

The Research Network's centralized IRB may help resolve these challenges.

Foundation: How has the AMDA Foundation Research Network helped or influenced you and your research?

McNabney: It involves community-based physicians who have tremendous experience and knowledge in the trenches and brings them together with synergy in forums to talk and create important, relevant research questions. The twice-annual meetings help maintain the momentum of the group and enable our projects to get off the ground and move forward. These meetings also keep people invested in the process. All of this translates into better studies.

Foundation: As the baby boomers age and other changes face long term care, what do you think the future of LTC research is? How will it change or evolve?

McNabney: The consistency of databases, how we use them, the ability to use large data sets, and the ability for them to be meaningful will evolve. We will have larger data sets that will provide accurate, meaningful information.

As LTC options increase, we will have to look at these more closely. And this will drive more funding, more attention, and more published studies in the literature.

We will become more sophisticated about who needs facility-based versus community-based care. We will better understand who needs institutional long term care and how to optimize care in this setting.