Disparities in Nursing Home Access for Patients with ADRD

项目摘要。养老院(NHS)不断攀升的肥胖率对这些人提出了独特的挑战 设施。为肥胖居民提供适当的护理可能代价高昂，因为肥胖居民有特殊的护理 满足这些需求需要在设备和员工时间方面进行额外的投资。然而， 目前的病例组合支付系统没有认识到与肥胖相关的额外成本(即 病例混合算法不对肥胖状态进行评级)，并且由此产生的潜在的反向经济激励可能 为肥胖居民提供高质量的护理设置障碍。重要的是要了解它的潜力 肥胖的NH居民面临的质量障碍，因为如果存在次优护理，不仅会损害肥胖 居民的健康状况，但也招致不必要的费用，如潜在的可预防的住院治疗， 在医疗保险计划中。到目前为止，关于这个问题的经验证据非常有限。我们的 先前的研究提供了一些初步发现，肥胖居民得到的护理质量低于非肥胖居民 肥胖居民沿着一个特定的维度--预防压疮。然而，NH质量是 多维衡量标准和质量衡量标准不一定要相互关联。目前还没有研究检查 肥胖居民的其他卫生保健质量结果是否存在差异，以及肥胖居民是否面临 获得高质量国民保健服务的障碍。因此，这项研究的目的是了解两者之间的差异 获得护理的机会和肥胖居民体验到的护理质量。基于一种经济概念 在框架内，这项研究有两个具体目标：1)使用多种衡量标准，检查护理质量的差异 (跌倒、可预防的住院等)，由肥胖和非肥胖居民在同一设施内接受， 以及这种差距是否因设施所有权、州医疗补助报销率和市场而异 因素；2)了解在获得高质量国民保健服务方面的差距--即肥胖居民是否较少 高质量的NHS可能比非肥胖居民更容易被录取--以及高质量成绩单的影响。 这项研究具有创新性，因为它是第一个使用一套全面的质量衡量标准来检查 NH肥胖居民接受的护理质量；它使用一个经济框架来探索不同的 路径(即在医院内接受的护理和进入高质量设施的障碍)可能导致 肥胖和非肥胖居民之间护理质量的总体差异；并探索了质量如何 差距因“外部因素”而异，如国家医疗补助政策和市场因素，这不仅会 提供与政策相关的影响，但也提供关于NH在质量结果中的作用的进一步证据 肥胖居民所经历的。这项拟议的研究具有重要意义，因为它解决了一个新兴的和 公众日益关注的问题。此外，它还将提供有关肥胖居民护理需求的信息。 和政策干预的需要，其目标是减少健康差距，实现更好的护理和 降低医疗成本。

Project Summary. The escalating rates of obesity in nursing homes (NHs) present unique challenges to these facilities. Providing appropriate care to obese residents can be costly as obese residents have special care needs and accommodating these needs requires additional investment in equipment and staff time. However, the current case-mix payment systems do not recognize the additional costs associated with obesity (i.e. the case-mix algorithm is not rated on obesity status), and the resulting potential inverse financial incentives may create barriers for obese residents to receive high quality of care. It is important to understand the potential quality barriers faced by obese NH residents because suboptimal care, if existing, will not only impair obese residents' health conditions, but also incur unnecessary costs, such as potentially preventable hospitalizations, on the Medicare program. To date, there has been very limited empirical evidence bearing on this issue. Our prior study provided some preliminary findings that obese residents received lower quality of care than non- obese residents along one specific dimension - the prevention of pressure ulcers. However, the NH quality is multidimensional and quality measures are not necessarily to be correlated. There are no studies examining whether disparity exists in other NH quality outcomes for obese residents, and whether obese residents face barriers in accessing high quality NHs. Thus, the objective of this study is to understand disparities both in access to care and in quality of care experienced by obese residents. Based on an economic conceptual framework, the study has 2 specific aims: 1) Examine the disparity in quality of care, using multiple measures (fall, preventable hospitalizations etc.), received by obese and non-obese residents within the same facility, and whether such disparity varies with the facility ownership, state Medicaid reimbursement rate and market factors; 2) Understand the disparity in access to high quality NHs – that is, whether obese residents are less likely to be admitted to high quality NHs than non-obese residents – and the impact of quality report cards. This study is innovative because it is the first one to use a comprehensive set of quality measures to examine quality of care received by obese NH residents; it employs an economic framework to explore different pathways (i.e. care received within a NH and barriers to access to high quality facilities) that can lead to the overall difference in quality of care between obese and non-obese residents; and it explores how the quality gap varies with “external factors” such as state Medicaid policies and market factors, which will not only provide policy relevant implications, but also provide further evidence on the role of NH in the quality outcomes experienced by obese residents. This proposed research is significant because it addresses an emerging and growing public concern. Furthermore, it will provide information on the needs of care among obese residents and needs of policy interventions, with the goal of reducing health disparities, achieving better care and reducing health care costs.