Are Patients With Serious Mental Illness More Likely to be Admitted to Nursing Homes With More Deficiencies in Care?
Are Patients With Serious Mental Illness More Likely to be Admitted to Nursing Homes With More Deficiencies in Care?
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DOI：
10.1097/mlr.0b013e318202ac10
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发表时间：
2011-04-01
期刊：
影响因子：
3
通讯作者：
Cram, Peter
中科院分区：
文献类型：
--
作者：
Li, Yue;Cai, Xueya;Cram, Peter
背景：符合养老院安置资格的被诊断为严重精神疾病(SMI)的患者往往需要高水平的精神护理和护理。然而，与其他患者相比，他们是否同样有可能进入护理质量足够高的养老院尚不清楚。方法：我们使用最低数据集分析了2007年全国130多万新入住养老院的队列。每个机构的总缺陷引用和与医疗保健相关的缺陷引用来自在线调查、认证和报告文件。结果：与其他患者相比，精神分裂症患者(n=23,767)倾向于进入养老院，总数(13.3vs.11.2，P<；0.001)和与医疗保健相关的缺陷(8.6vs.7.2，P<；0.001)；双相情感障碍(n=19,741)患者也更有可能进入有更多问题护理的机构(12.5vs.11.2，P<；0.001)。医疗保健相关缺陷的比例为8.2vs.7.2，P<；0.001)。在对县内设施选择、患者特征和设施协变量进行序贯控制后，SMI与入住缺陷程度较高的养老院之间的关联仍然存在。结论：精神分裂症或双相情感障碍(SMI)患者比其他患者更有可能进入总体质量和临床护理质量缺陷引用较高的养老院。有必要进行进一步的研究，以了解与SMI相关的养老院护理质量差异背后的原因。
Background: Patients diagnosed with serious mental illness (SMI) who qualify for nursing home placement tend to require high levels of both psychiatric and nursing care. However, it is unknown whether they are equally likely to be admitted to nursing homes with adequate quality of care compared with other patients.Methods: We analyzed a national cohort of more than 1.3 million new nursing home admissions in 2007 using the minimum data set. The total and healthcare-related deficiency citations for each facility were obtained from the Online Survey, Certification, and Reporting file. Bivariate and multivariate regression analyses determined the association of schizophrenia or bipolar disorder with admissions to facilities with higher deficiencies.Results: Compared with other patients, patients with schizophrenia (n = 23,767) tended to enter nursing homes with more total (13.3 vs. 11.2, P < 0.001) and healthcare-related deficiencies (8.6 vs. 7.2, P < 0.001); and patients with bipolar disorder (n = 19,741) were more likely to enter facilities with more problematic care too (12.5 vs. 11.2, P < 0.001 for total deficiencies; and 8.2 vs. 7.2, P < 0.001 for healthcare-related deficiencies). After sequentially controlling for the within-county choice of facilities, patient characteristics, and facility covariates, the association of SMI with admitting to higher-deficiency nursing homes persisted.Conclusions: Patients diagnosed with schizophrenia or bipolar disorder (ie, SMI) were more likely than other patients to be admitted to nursing homes with higher deficiency citations for both overall quality and clinical care quality. Further research is necessary to understand the reasons behind the disparity in quality of nursing home care associated with SMI.