Pressure Ulcer Prevalence Among Black and White Nursing Home Residents in New York State Evidence of Racial Disparity?
Pressure Ulcer Prevalence Among Black and White Nursing Home Residents in New York State Evidence of Racial Disparity?
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DOI：
10.1097/mlr.0b013e3181ca2810
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发表时间：
2010-03-01
期刊：
影响因子：
3
通讯作者：
Temkin-Greener, Helena
中科院分区：
文献类型：
--
作者：
Cai, Shubing;Mukamel, Dana B.;Temkin-Greener, Helena
目的：发生压疮（PU）在疗养院是一个标志，护理质量差。我们研究是否黑人和白色居民之间的PU患病率的差异是由于内部或跨facilityvariables.Methods：最小数据集（2006-2007年）与在线调查认证和报告数据库。长期护理居民与高风险的PU确定。因变量是二分的，指示PU存在/不存在。个人种族和设施种族组合是主要的利益变量。该样本包括619家养老院的59，740名长期护理高风险居民（17.4%黑人和82.6%白色）。我们拟合3个风险调整的logit模型：基础，条件固定效应，和random-effects.Results：未经调整的PU患病率为14.5%（18.2%为黑人和13.8%为白人）。总体而言，黑人比白人更容易患PU，控制了个体风险因素。我们发现，在额外考虑设施固定效应后，设施内没有这种效应。种族的影响是显着不同的基础和条件固定效应logit模型。的随机效应和条件固定效应的logit模型显示出类似的结果，表明更高的PU黑人之间的存在与更大的设施特定浓度的黑人resident.Conclusion：更大的PU黑人之间的发生可能不会导致差异设施内治疗的黑人与白人。相反，黑人更有可能居住在护理质量较差的设施中。为改善PU对黑人的护理，应努力提高黑人居民比例高的设施的整体护理质量。
Objective: The occurrence of pressure ulcers (PUs) in nursing homes is a marker for poor quality of care. We examine whether differences in PU prevalence between black and white residents are due to within-or across-facility disparities.Methods: Minimum Data Sets (2006-2007) are linked with the Online Survey Certification and Reporting database. Long-term care residents with high risk for PUs are identified. The dependent variable is dichotomous, indicating PU presence/absence. Individual race and facility race-mix are the main variables of interests. The sample includes 59,740 long-term care high-risk residents (17.4% black and 82.6% white) in 619 nursing homes. We fit 3 risk-adjusted logit models: base, conditional fixed-effects, and random-effects.Results: Unadjusted PU prevalence is 14.5% (18.2% for blacks and 13.8% for whites). Overall, blacks are more likely to have PUs than whites, controlling for individual risk factors. We find no such effect within facilities after additional accounting for facility fixed effects. The effect of race is significantly different between the base and the conditional fixed-effects logit model. The random-effects and conditional fixed-effects logit models show similar results, demonstrating that higher PU presence among blacks is associated with greater facility-specific concentration of black residents.Conclusion: Greater PU occurrence among blacks may not result from differential within-facility treatment of blacks versus whites. Rather, blacks are more likely to reside in facilities with poorer care quality. To improve PU care for blacks, efforts should focus on improving the overall quality of care for facilities with high proportion of black residents.