Disparities in Nursing Home Access for Patients with ADRD

项目摘要。养老院（NHs）中肥胖率的不断上升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是昂贵的，因为肥胖居民需要特殊护理。 需要和满足这些需要在设备和工作人员时间方面进行额外投资。然而，在这方面， 目前的病例组合支付系统没有认识到与肥胖相关的额外费用（即， 病例组合算法不对肥胖状态进行评级），并且由此产生的潜在反向经济激励可能 为肥胖居民接受高质量的护理制造障碍。重要的是要了解潜在的 肥胖的NH居民面临质量障碍，因为如果存在次优护理，不仅会损害肥胖 居民的健康状况，但也产生不必要的费用，如潜在的可预防的住院治疗， 医疗保险计划。迄今为止，与这一问题有关的经验证据非常有限。我们 先前的研究提供了一些初步的发现，肥胖的居民得到的护理质量低于非肥胖的居民， 肥胖居民沿着一个特定的维度--预防压疮。然而，NH质量是 多维和质量度量不一定相互关联。没有研究 肥胖居民的其他NH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NHS的障碍。因此，本研究的目的是了解差异， 获得保健和保健质量的肥胖居民所经历的。基于一个经济概念 框架，该研究有2个具体目标：1）检查护理质量的差异，使用多种措施 (fall可预防的住院治疗等），肥胖和非肥胖的居民在同一设施内接受， 以及这种差异是否因设施所有权、州医疗补助报销率和市场而异 因素; 2）了解获得高质量NHS的差距-也就是说，肥胖居民是否较少 比非肥胖居民更有可能被录取到高质量的NHS-以及质量报告卡的影响。 本研究具有创新性，因为它是第一个使用一套全面的质量测量方法来检验 肥胖的NH居民接受的护理质量;它采用经济框架来探索不同的 途径（即在NH内接受的护理和获得高质量设施的障碍），可能导致 肥胖和非肥胖居民之间的护理质量的总体差异;它探讨了如何质量 差距随着“外部因素”而变化，如国家医疗补助政策和市场因素，这不仅 提供政策相关的影响，但也提供进一步的证据，在质量成果的作用，NH 肥胖的居民所经历的。这项拟议的研究是重要的，因为它解决了一个新兴的， 公众越来越关注。此外，它还将提供有关肥胖居民护理需求的信息 政策干预的需要，目标是减少健康差距，实现更好的护理， 降低医疗费用。

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.