Quality of Nursing Homes Among ADRD Residents Newly Admitted From the Community: Does Race Matter?
Quality of Nursing Homes Among ADRD Residents Newly Admitted From the Community: Does Race Matter?
复制标题
新入社区的 ADRD 居民的疗养院质量：种族重要吗？
DOI：
10.1016/j.jamda.2023.01.017
复制
发表时间：
2023
影响因子：
7.6
通讯作者：
Temkin-Greener,Helena
中科院分区：
文献类型：
--
作者：
Cai,Shubing;Yan,Di;Wang,Sijiu;Temkin-Greener,Helena
目的研究阿尔茨海默病和相关痴呆（ADRD）患者入住高质量疗养院（NHs）的种族差异，以及这种种族差异是否会受到与痴呆相关的州医疗补助附加政策的影响。2011年和2017年12月31日。方法2010 -2017年最小数据集3.0，医疗保险受益人摘要文件，医疗保险提供者分析和审查，以及护理之家比较数据相关联。对于每一个人，我们构建了一个“选择”的NH之间的距离和个人住宅邮政编码的基础上的NH集。McFadden的选择模型进行了估计，以检查进入一个高品质的（4-或5-星星）NH和个人特征，特别是种族，和国家医疗补助痴呆症相关的附加policy.ResultsAmong确定的居民，89%是白色，11%是黑色之间的关系。总体而言，50%的白色和35%的黑人被高质量的NHS录取。黑人更有可能获得医疗保险和医疗补助双重资格。McFadden模型的结果表明，黑人比白色人更不容易被高质量的NH录取（OR = 0.615，P <0.01），这种差异部分地由个体特征解释。此外，我们发现，与没有这些政策的州相比，在有痴呆相关附加政策的州，种族差异减少了（OR = 1.16，P <0.01）。结论和含义与白色个体相比，患有ADRD的黑人个体更不可能被高质量的NHS录取。这种差异部分与个人的健康状况，社会经济地位和国家医疗补助附加政策有关。政策，以减少黑人个人之间的高质量的NHS的障碍是必要的，以减轻健康不平等，在这个弱势群体。
ObjectiveTo examine racial differences in admissions to high-quality nursing homes (NHs) among residents with Alzheimer disease and related dementias (ADRD), and whether such racial differences can be influenced by dementia-related state Medicaid add-on policies.DesignRetrospective cross-sectional study.Setting and ParticipantsThe study included 786,096 Medicare beneficiaries with ADRD newly admitted from the community to NHs between January 1, 2011 and December 31, 2017.Methods2010–2017 Minimum Data Set 3.0, Medicare Beneficiary Summary File, Medicare Provider Analysis and Review, and Nursing Home Compare data were linked. For each individual, we constructed a “choice” set of NHs based on the distance between the NH and an individual residential zip code. McFadden's choice models were estimated to examine the relationship between admission into a high-quality (4- or 5-star) NH and individual characteristics, specifically race, and state Medicaid dementia-related add-on policies.ResultsAmong the identified residents, 89% were White, and 11% were Black. Overall, 50% of White and 35% of Black individuals were admitted to high-quality NHs. Black individuals were more likely to be Medicare-Medicaid dually eligible. Results from McFadden's model suggested that Black individuals were less likely to be admitted to a high-quality NH than White individuals (OR = 0.615,P< .01), and such differences were partially explained by some individual characteristics. Furthermore, we found that the racial difference was reduced in states with dementia-related add-on policies, compared with states without these policies (OR = 1.16,P< .01).Conclusions and ImplicationsBlack individuals with ADRD were less likely to be admitted to high-quality NHs than White individuals. Such difference was partially related to individuals' health conditions, social-economic status, and state Medicaid add-on policies. Policies to reduce barriers to high-quality NHs among Black individuals are necessary to mitigate health inequity in this vulnerable population.