Association of Race and Sites of Care With Pressure Ulcers in High-Risk Nursing Home Residents
Association of Race and Sites of Care With Pressure Ulcers in High-Risk Nursing Home Residents
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DOI：
10.1001/jama.2011.942
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发表时间：
2011-07-13
影响因子：
120.7
通讯作者：
Mukamel, Dana B.
中科院分区：
文献类型：
--
作者：
Li, Yue;Yin, Jun;Mukamel, Dana B.
目的确定高危长期入住疗养院居民中压疮患病率的种族差异的纵向趋势，并评估持续差异是否与居民接受护理的地点有关。设计、设置和参与者对美国12 473家认证疗养院的210万白人和346 808名黑人居民的压疮发生率进行观察性队列研究，使用疗养院居民评估；在线调查、认证和报告文件；以及2003年至2008年的地区资源文件。根据黑人居民的比例对养老院进行分类。主要结果衡量护理地点之间和护理地点内的风险调整种族差异，以及在不同养老院设施接受护理的黑人和白人居民在第二阶段到第四阶段发生压疮的风险调整后的几率。结果从2003年到2008年，压疮发生率总体下降，但养老院的黑人居民压疮发生率持续高于白人居民。2003年，黑人养老院居民压疮发生率为16.8%(95%可信区间，16.6%~17.0%)，白人居民为11.4%(95%可信区间，11.3%~11.5%)；2008年，黑人居民压疮发生率为14.6%(95%可信区间，14.4%~14.8%)，白人居民压疮发生率为9.6%(95%可信区间，9.5%~9.7%)(P>；差异趋势0.05)。在黑人居民比例最高的养老院(>；=35%)，黑人居民(2008年未调整比率为15.5%[95%CI，15.2%-15.8%]；调整后的优势比[AOR]，1.59[95%CI，1.52-1.67])和白人居民(未调整比率为12.1%[95%CI，11.8%-12.4%]；AOR，1.33[95%CI，1.26-1.40])与主要服务于白人居民的疗养院(黑人居民集中)相比，压疮的发生率更高
Context A variety of nursing home quality improvement programs have been implemented during the last decade but their implications for racial disparities on quality are unknown.Objectives To determine the longitudinal trend of racial disparities in pressure ulcer prevalence among high-risk, long-term nursing home residents and to assess whether persistent disparities are related to where residents received care.Design, Setting, and Participants Observational cohort study of pressure ulcer rates in 2.1 million white and 346 808 black residents of 12 473 certified nursing homes in the United States that used the nursing home resident assessment; Online Survey, Certification, and Reporting files; and Area Resource Files for 2003 through 2008. Nursing homes were categorized according to their proportions of black residents.Main Outcome Measures Risk-adjusted racial disparities between and within sites of care and risk-adjusted odds of pressure ulcers in stages 2 through 4 for black and white residents receiving care in different nursing home facilities.Results Pressure ulcer rates decreased overall from 2003 through 2008 but black residents of nursing homes showed persistently higher pressure ulcer rates than white residents. In 2003, the pressure ulcer rate was 16.8% (95% confidence interval [CI], 16.6%-17.0%) for black nursing home residents compared with 11.4% (95% CI, 11.3%-11.5%) for white residents; in 2008, the rate was 14.6% (95% CI, 14.4%-14.8%) compared with 9.6%(95% CI, 9.5%-9.7%), respectively (P>.05 for trend of disparities). In nursing homes with the highest percentages of black residents (>= 35%), both black residents (unadjusted rate of 15.5% [95% CI, 15.2%-15.8%] in 2008; adjusted odds ratio [AOR], 1.59 [95% CI, 1.52-1.67]) and white residents (unadjusted rate of 12.1% [95% CI, 11.8%12.4%]; AOR, 1.33 [95% CI, 1.26-1.40]) had higher rates of pressure ulcers than nursing homes serving primarily white residents (concentration of black residents