Rurality and Nursing Home Quality: Evidence From the 2004 National Nursing Home Survey
Rurality and Nursing Home Quality: Evidence From the 2004 National Nursing Home Survey
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DOI：
10.1093/geront/gnr065
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发表时间：
2011-12-01
期刊：
影响因子：
5.7
通讯作者：
Miller, Nancy A.
中科院分区：
文献类型：
--
作者：
Kang, Yu;Meng, Hongdao;Miller, Nancy A.
研究目的：评估农村地理位置对美国养老院护理质量的影响。设计与方法：本研究采用横断面观察性设计。我们从2004年全国养老院调查中获得了1,174家养老院12,507名居民的居民和设施水平的数据。我们使用多水平回归模型来预测住院、流感和肺炎球菌疫苗接种以及中度到重度疼痛的风险调整率，同时控制居民和设施的特征。结果：调整协变量后，农村居民住院(优势比[OR]=1.50，95%可信区间[CI]=1.16~1.94)和中重度疼痛(OR=1.68，95%CI=1.35~2.09)的发生率较高。更高质量的显著设施级别预测因素包括更高比例的医疗补助受益人、认证状态和特殊护理计划。医疗保险支付结果喜忧参半。重要的居民水平预测因素包括痴呆症诊断和长期居住。影响：农村居民更有可能居住在没有认证或特殊护理计划的设施中，这些因素增加了他们接受较差护理质量的几率。加强医疗保险支付方式的政策努力，以及提高农村设施的认证地位和提供特殊护理方案，可能会减少设施中的护理质量差距。
Purpose of the Study: To evaluate the impact of rural geographic location on nursing home quality of care in the United States. Design and Methods: The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Results: Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Implications: Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.