Impacts of nursing home competition & state policies on disparities in quality

项目简介/摘要2004年，少数族裔/族裔人士约占养老院人口的16%。最近的数据显示，住在养老院的少数族裔人数正在急剧增加，而住在养老院的白人人数却在下降。这些新的人口变化引起了人们的关注，即养老院是否能够适当地满足日益多样化的种族和文化背景患者的需求。养老院提供的护理质量一直是困扰该行业的一个长期问题，也是联邦和州旨在改善护理质量的政策的重点。现有证据表明，这些政策，包括加强国家质量法规，改善医疗补助报销，以及最近促进市场竞争的努力（例如，废除需求证明要求；国家质量报告），在过去十年中改善了养老院的质量和结果。随着行业的发展和质量的提高，以应对这些政策和市场趋势，重要的是要认识到，整体养老院质量的提高可能不会自动使所有亚组患者平等受益。事实上，尽管有证据表明总体上有所改善，但大量文献继续记录了养老院质量的种族/民族差异。特别是，我们最近发表在《美国医学协会杂志》上的研究首次提供了证据，证明尽管非西班牙裔白人和少数族裔在养老院的压疮治疗结果有所改善，但两组患者之间的差距仍未改变。因此，本提案的总体目标是回答两个非常重要的问题：1)这种伴随着种族/民族群体之间持续差距的质量提高的现象，是否存在于其他已知的养老院护理差异领域？2)我们能否找出在提高质量和缩小质量的种族和民族差距方面取得成功的具体政策和市场特征？拟议的项目将通过调查三种主要类型的养老院质量驱动因素——国家质量监管、医疗补助报销和市场竞争——对种族/民族质量差距及其持久性的纵向和横向影响来实现这些目标。本项目产生的信息将有助于了解主要养老院政策影响护理公平的方式。

DESCRIPTION (provided by applicant): Project Summary/Abstract Racial/ethnic minorities made up about 16 percent of the nursing home population in 2004. More recent data suggest that the number of minority nursing homes residents is increasing dramatically, while the number of white residents is declining. These new demographic changes raise concerns about whether nursing homes are able to serve appropriately the needs of patients with increasingly diverse ethnic and cultural backgrounds. The quality of care delivered in nursing homes has been a longstanding issue plaguing the industry, and continues to be the focus of federal and state policies aimed at improving it. Extant evidence suggests that these policies, including strengthened state quality regulations, improved Medicaid reimbursements, and more recent efforts to foster market competition (e.g., the repeal of the Certificate of Need requirement; the national quality reporting), have improved nursing home quality and outcomes during the past decade. As the industry makes headway and improves quality in response to these policy and market trends, it is important to recognize that improvements in overall nursing home quality may not automatically benefit all subgroups of patients equally. Indeed, despite evidence of overall improvements, a large body of literature continues to document racial/ethnic disparities in nursing home quality. In particular, our recent work, published in the Journal of American Medical Association, has for the first time provided evidence that while pressure ulcer outcomes in nursing homes have improved for both non-Hispanic whites and minorities, the gap between these two groups of patients remained unchanged. Thus, the overall goal of this proposal is to answer two very important questions: 1) Does this phenomenon, of improvement in quality for all concomitant with a persistent gap between racial/ethnic groups, exist in other areas of known disparities for nursing home care? and 2) Can we identify specific policy and market characteristics that have been successful not only in improving quality but also in closing the racial and ethnic gap in quality? The proposed project will achieve these goals by investigating the longitudinal and cross sectional impact of each of three major types of nursing home quality drivers - state regulation of quality, Medicaid reimbursement, and market competition - on the racial/ethnic quality gap and its persistence. The information generated by this project will contribute to the knowledge regarding the ways with which major nursing home policies impact equity of care.