FACILITY EFFECTS ON RACIAL DIFFERENCES IN NURSING HOME Q

疗养院设施对种族差异的影响 Q

• 批准号: 6053780
• 负责人: MARY L FENNELL
• 金额: $ 26.71万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-30 至 2001-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6053780
• 关键词: antipsychotic agents; clinical research; depression; health care model; health care quality; health care service evaluation; health services research tag; human population study; human subject; nursing homes; pain; patient care; racial /ethnic difference; ulcer; urinary incontinence

Although our methods for measuring quality of care in nursing homes have improved substantially, we still lack a clear understanding of how nursing home structure and local community context may influence quality of care. We also lack an understanding of how segregation of access to nursing homes by minority elders is related to differences in quality of care received by white and minority nursing home residents. The specific aims of this study are: 1) To quantify the extent to which access to nursing home care is segregated by race/ethnicity; 2) Using state-of-the-art indicators of care quality in long term care nursing facilities, develop a measure of racial/ethnic disparities in care quality that compares the odds of receiving poor quality care for whites and nonwhites; 3) To examine variation in and relationships between the two separate concepts of nursing home quality of care and racial/ethnic disparities in nursing home quality of care; 4) Using a smaller subset of facilities from this population that are participating in an existing panel study, to test for the effects of demographic "mismatch" between community and nursing home staff on racial/ethnic disparity in nursing home care quality; and 5) To develop and test a multilevel model explaining variation in nursing home quality of care as well as racial/ethnic disparities in nursing home quality of care as a function of patient level, facility level and community level factors. We propose to use recently validated measures of care quality to develop racial/ethnic disparity measures in 6 different areas of care (pain management, pressure ulcers, depression management, use of restraints, use of antipsychotic drugs and incontinence management), and we will compare the quality of nursing home care received by whites, African Americans, Native Americans and non-white Hispanics. The Strategic Assessment of Geriatric Drug Use and Epidemiology (SAGE) Database will provide the core data for this project on over 7000 nursing homes in seven different states, with a smaller subanalysis of 308 nursing homes from the Do Good Nursing Homes project.

尽管我们衡量疗养院护理质量的方法已经有了很大改进，但我们仍然对疗养院结构和当地社区环境如何影响护理质量缺乏清晰的了解。 我们还缺乏了解，少数族裔老年人进入疗养院的隔离与白人和少数族裔疗养院居民接受的护理质量差异有何关系。 本研究的具体目的是： 1) 量化获得疗养院护理的机会按种族/民族划分的程度； 2) 在长期护理机构中使用最先进的护理质量指标，制定护理质量中种族/民族差异的衡量标准，比较白人和非白人接受低质量护理的几率； 3) 研究疗养院护理质量这两个独立概念之间的差异和关系以及疗养院护理质量的种族/民族差异； 4) 使用参与现有小组研究的该人群中较小的设施子集，来测试社区和疗养院工作人员之间的人口“不匹配”对疗养院护理质量中种族/民族差异的影响； 5) 开发和测试一个多层次模型，解释疗养院护理质量的变化以及疗养院护理质量的种族/民族差异作为患者水平、设施水平和社区水平因素的函数。 我们建议使用最近经过验证的护理质量衡量标准，在 6 个不同的护理领域（疼痛管理、压疮、抑郁管理、约束的使用、抗精神病药物的使用和失禁管理）制定种族/民族差异衡量标准，并且我们将比较白人、非裔美国人、美洲原住民和非白人西班牙裔人接受的疗养院护理的质量。 老年药物使用和流行病学战略评估 (SAGE) 数据库将为该项目提供七个不同州 7000 多家疗养院的核心数据，并对来自 Do Good Nursing Homes 项目的 308 家疗养院进行较小的子分析。