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

说明(由申请人提供)：项目摘要/摘要2004年，少数民族约占疗养院人口的16%。最近的数据显示，少数族裔养老院的居民数量正在急剧增加，而白人居民的数量正在下降。这些新的人口结构变化引发了人们的担忧，即养老院是否能够适当地服务于日益多样化的种族和文化背景的患者的需求。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，也一直是旨在改善这一问题的联邦和州政策的重点。现有证据表明，这些政策，包括加强州质量监管、改善医疗补助报销，以及最近促进市场竞争的努力(例如，废除需要证明要求；国家质量报告)，在过去十年中改善了养老院的质量和结果。随着该行业根据这些政策和市场趋势取得进展并提高质量，重要的是要认识到，整体疗养院质量的改善可能不会自动平等地惠及所有患者亚群。事实上，尽管有证据表明养老院的整体状况有所改善，但大量文献仍在记录养老院质量方面的种族/民族差异。特别是，我们最近发表在《美国医学会杂志》上的研究首次证明，尽管疗养院的压疮结果对非西班牙裔白人和少数族裔都有所改善，但这两组患者之间的差距保持不变。因此，这项提案的总体目标是回答两个非常重要的问题：1)在疗养院护理方面存在已知差距的其他领域是否存在这种现象，即改善所有人的质量，同时伴随着种族/民族之间的持续差距？2)我们能否确定不仅在提高质量方面而且在缩小种族和民族在质量上的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续性的纵向和横向影响，来实现这些目标。这个项目产生的信息将有助于了解主要的养老院政策如何影响护理公平。

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.