Environmental and structural factors driving poor quality of care: An examination of nursing homes serving Black residents.
Environmental and structural factors driving poor quality of care: An examination of nursing homes serving Black residents.
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导致护理质量差的环境和结构因素：对为黑人居民提供服务的疗养院的检查。
DOI：
10.1111/jgs.18459
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发表时间：
2023
影响因子：
6.3
通讯作者：
Stone,PatriciaW
中科院分区：
文献类型：
--
作者：
Travers,JasmineL;Castle,Nicholas;Weaver,SusanH;Perera,UduwanageG;Wu,Bei;Dick,AndrewW;Stone,PatriciaW
背景黑人居民占很高比例的养老院的护理质量低下一直是美国的一个问题，在新冠肺炎疫情期间更加明显。联邦和州机构正在致力于确定改善最有需要的设施中的护理的最佳手段。重要的是要了解环境和结构特征，这些特征可能导致NHS在大流行前为高比例的黑人居民服务的医疗保健结果不佳。方法我们使用多个2019年国家数据集进行了一项横断面观察性研究。我们的风险敞口是NH中黑人居民的比例(即无，5%，5%-19.9%，20%-49.9%，≥50%)。检查的医疗结果是住院和急诊科(ED)就诊，两者都进行了观察和风险调整。结构性因素包括人员配备、所有权状况、床位数量(0-49、50-149或≥150)、连锁组织成员、入住率以及作为支付来源的医疗补助百分比。环境因素包括地域性和都市性。结果在14,121个NHS中，与没有黑人居民的NHS相比，黑人居民占≥50%的NHS更倾向于城市、营利性、位于南部的居民，有更多的医疗补助资助居民，注册护士(RN)和每名住院医生每天的辅助小时数(HPRD)比例较低，执业护士HPRD比例较高。一般来说，随着黑人居民在NH中的比例增加，住院和急诊也增加。讨论/影响由于在NHS中，RN的使用较少与急诊和住院的增加相关，因此很可能在很大程度上，RN的低使用在很大程度上推动了NHS中黑人居民比例较高的住院和急诊的差异。人员配备是州和联邦机构应该采取行动提高黑人居民比例较大的NHS的护理质量的一个领域。
BackgroundPoor quality of care in nursing homes (NHs) with high proportions of Black residents has been a problem in the US and even more pronounced during the COVID‐19 pandemic. Federal and state agencies are devoting attention to identifying the best means of improving care in the neediest facilities. It is important to understand environmental and structural characteristics that may have led to poor healthcare outcomes in NHs serving high proportions of Black residents pre‐pandemic.MethodsWe conducted a cross‐sectional observational study using multiple 2019 national datasets. Our exposure was the proportion of Black residents in a NH (i.e., none, <5%, 5%–19.9%, 20–49.9%, ≥50%). Healthcare outcomes examined were hospitalizations and emergency department (ED) visits, both observed and risk‐adjusted. Structural factors included staffing, ownership status, bed count (0–49, 50–149, or ≥150), chain organization membership, occupancy, and percent Medicaid as a payment source. Environmental factors included region and urbanicity. Descriptive and multivariable linear regression models were estimated.ResultsIn the 14,121 NHs, compared to NHs with no Black residents, NHs with ≥50% Black residents tended to be urban, for‐profit, located in the South, have more Medicaid‐funded residents, and have lower ratios of registered‐nurse (RN) and aide hours per resident per day (HPRD) and greater ratios of licensed practical nurse HPRD. In general, as the proportion of Black residents in a NH increased, hospitalizations and ED visits also increased.Discussion/ImplicationsAs lower use of RNs has been associated with increased ED visits and hospitalizations in NHs generally, it is likely low RN use largely drove the differences in hospitalizations and ED visits in NHs with greater proportions of Black residents. Staffing is an area in which state and federal agencies should take action to improve the quality of care in NHs with larger proportions of Black residents.