FACILITY EFFECTS ON RACIAL DIFFERENCES IN NH QUALITY

虽然我们衡量养老院护理质量的方法有了很大的改进，但我们仍然缺乏对养老院结构和当地社区环境如何影响护理质量的清晰理解。我们也缺乏对少数民族老年人进入养老院的隔离与白人和少数民族养老院居民所接受的护理质量差异之间的关系的理解。本研究的具体目的是：1)量化获得养老院护理的程度按种族/民族隔离；2)利用最先进的长期护理机构护理质量指标，制定一种衡量护理质量的种族/民族差异的方法，比较白人和非白人接受低质量护理的几率；3)检验养老院护理质量的两个独立概念与养老院护理质量的种族/民族差异之间的差异和关系；4)从参与现有小组研究的人口中选取一小部分设施，以测试社区和养老院工作人员之间的人口“不匹配”对养老院护理质量的种族/民族差异的影响；5)开发和检验一个多层次模型，解释疗养院护理质量的差异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。我们建议使用最近验证过的护理质量措施，在6个不同的护理领域（疼痛管理、压疮管理、抑郁管理、约束的使用、抗精神病药物的使用和失禁管理）中制定种族/民族差异措施，我们将比较白人、非洲裔美国人、美洲原住民和非白人西班牙裔美国人接受的养老院护理质量。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7个不同州7000多家养老院的核心数据，并对来自“善待养老院”项目的308家养老院进行较小的子分析。

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.