Nurse Staffing Hours At Nursing Homes With High Concentrations Of Minority Residents, 2001-11
Nurse Staffing Hours At Nursing Homes With High Concentrations Of Minority Residents, 2001-11
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DOI：
10.1377/hlthaff.2015.0422
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发表时间：
2015-12-01
期刊：
影响因子：
9.7
通讯作者：
Temkin-Greener, Helena
中科院分区：
文献类型：
--
作者：
Li, Yue;Harrington, Charlene;Temkin-Greener, Helena
最近，州政府向养老院支付的医疗补助金额增加，有可能缩小种族/少数民族居民高度集中和低集中的疗养院之间的护士人员配备差距。对2001年至2011年期间疗养院和国家政策调查数据的分析表明，在此期间，注册护士和执业护士的人员配置水平略有增加，无论种族/少数民族居民集中程度如何。少数民族居民高密度和低密度的疗养院之间每天登记护士小时数的调整后差距仍然存在，尽管差距有所缩小。在少数民族人口密度较低的疗养院，患者每天的认证护理助理小时数增加，但在少数民族人口密度较高的家庭，患者每天的认证护理助理小时数减少，造成了新的差距。总体而言，向养老院支付的州医疗补助费率的增加与人员配备的改善和设施之间人员配备差距的缩小有关，但采用病例组合支付方式产生了相反的效果。需要进一步改革医疗服务的提供和支付，以解决服务于较高比例的少数族裔居民和服务于较低比例的疗养院之间长期存在的护理差距，并防止这种差距意外加剧。
Recent increases in state Medicaid payments to nursing homes have the potential to reduce disparities in nurse staffing between facilities with high and low concentrations of racial/ethnic minority residents. Analyses of nursing home and state policy survey data for the period 2001-11 suggest that registered nurse and licensed practical nurse staffing levels increased slightly during this period, regardless of racial/ethnic minority resident concentration. Adjusted disparities in registered nurse hours per resident day between nursing homes with high and low concentrations of minority residents persisted, although they were reduced. Certified nursing assistant hours per patient day increased in nursing homes with low concentrations of minorities but decreased in homes with high concentrations, creating a new disparity. Overall, increases in state Medicaid payment rates to nursing homes were associated with improvements in staffing and reduced staffing disparities across facilities, but the adoption of case-mix payments had the opposite effect. Further reforms in health care delivery and payment are needed to address persistent disparities in care between nursing homes serving higher proportions of minority residents and those serving lower proportions, and to prevent unintended exacerbations of such disparities.