The Quality of Nursing Homes That Serve Patients With Human Immunodeficiency Virus
The Quality of Nursing Homes That Serve Patients With Human Immunodeficiency Virus
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DOI：
10.1111/jgs.16155
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发表时间：
2019-08-29
影响因子：
6.3
通讯作者：
Rahman, Momotazur
中科院分区：
文献类型：
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作者：
Meyers, David J.;Wilson, Ira B.;Rahman, Momotazur
随着全国人类免疫缺陷病毒（HIV）感染者的年龄增长，他们将需要更多的急性后和长期护理。很少有人知道的质量疗养院（NHs）的艾滋病毒感染者被接纳。在这项研究中，我们评估了每年进入一个给定的NH（艾滋病毒浓度）和NH的质量结果的艾滋病毒感染者的数量之间的关联。设计：横断面比较研究。从2001年到2012年，在九个州设置了NHS。对象共46 918 NH-年占67 301例艾滋病毒感染者入院。我们使用100% Medicaid分析提取物，最小数据集2.0和3.0，以及来自9个州的2001年至2012年的医疗保险索赔，以检查HIV浓度和NH质量之间的关联。根据所有现有数据来源，将这些人归类为艾滋病毒阳性，并计算新入院的艾滋病毒感染者的百分比（艾滋病毒浓度）。然后，我们比较了星星评级，再住院率，NH调查的缺陷，并限制使用NH的艾滋病毒入院的百分比，使用线性随机效应模型的差异。结果在调整NH特征、邮政编码特征、州和年份固定效应后，与没有HIV入院的人相比，HIV入院率大于0%-5%的NH的星星评级低0.6个百分点（P < .001），30天再住院率高0.4%（P < .01）。HIV感染率为5%~ 50%的NHS患者的缺陷率高7.0个百分点（P < .001），星星评分低0.1个百分点（P < .001），再住院率高1.5个百分点（P < .001）。结论与非HIV感染者相比，HIV感染者通常被低质量的NHS录取。需要作出更多努力，确保艾滋病毒感染者能够获得高质量的保健服务。
BACKGROUND/OBJECTIVES As the national population of persons living with human immunodeficiency virus (HIV) ages, they will require greater postacute and long-term care use. Little is known about the quality of nursing homes (NHs) to which patients with HIV are admitted. In this study, we assess the association between the number of persons with HIV admitted annually to a given NH (HIV concentration) and that NH's quality outcomes. DESIGN A cross-sectional comparative study. SETTING NHs in nine states, from 2001 to 2012. PARTICIPANTS A total of 46 918 NH-years accounting for 67 301 admissions by patients with HIV. MEASUREMENTS We used 100% Medicaid Analytic Extract, Minimum Dataset 2.0 and 3.0, and Medicare claims from 2001 to 2012 from nine states to examine the association between HIV concentration and NH quality. Persons were classified as HIV positive on the basis of all available data sources, and a NH's percentage of new admissions with HIV was calculated (HIV concentration). We then compared differences in star ratings, rehospitalization rates, NH survey deficiencies, and restraint use by a NH's percentage of admissions with HIV, using linear random effects models. RESULTS After adjusting for NH characteristics, zip code characteristics, and state and year fixed effects, NHs with greater than 0% to 5% of admissions with HIV had a 0.6 lower star rating (P < .001), and a 0.4% percentage point higher 30-day rehospitalization rate (P < .01), compared to those with no HIV admissions. NHs with 5% to 50% of admissions with HIV had 7.0 more deficiencies (P < .001), a 0.1 lower star rating (P < .001), and a 1.5 percentage point higher rehospitalization rate (P < .001). CONCLUSION Persons with HIV were generally admitted to lower-quality NHs compared to persons without HIV. More efforts are needed to ensure that persons with HIV have access to high-quality NHs.