Disparities in the Quality of Nursing Home Care

摘要 养老院护理的质量对老年人的健康和福祉是一个至关重要的问题。几十年来， 人们普遍担心美国养老院护理的质量以及差距 在不同群体中接受的护理质量。加剧这些问题的是对能力的担忧 患者(或他们的照顾者)评估疗养院质量，这对患者来说尤其尖锐 患有阿尔茨海默病或相关痴呆症(ADRD)。 我们建议记录医疗保险覆盖的养老院护理质量方面的差异程度 调查这些差距背后的力量，并评估潜在政策的影响 干预措施。我们将重点关注不同种族之间的差异(特别是非西班牙裔黑人患者 与白人非西班牙裔患者相比)、种族(西班牙裔患者与非西班牙裔患者相比 患者)、社会经济状况(患者在入院时是否双重参加医疗补助)和健康群体 (入院时有和没有ADRD的患者)。 为了实现这一目标，我们将在现有工作的基础上估计每家疗养院的平均附加值。 我们创建了一个评估这种增值的测量框架，可以应用于任何健康状况 在丰富的数据中测量(或健康测量的组合)患者的身体健康、心理健康、日常生活 医疗保险和医疗补助服务中心提供的功能、痴呆症和认知能力 最小数据集；这些评估涵盖联邦医疗保险和医疗补助认证疗养院的所有患者。 我们建议扩展我们的框架，允许增值在不同的患者群体中有所不同 每个养老院，然后用它来记录养老院质量差异的程度 按组体验。然后，我们将检查增值方面的差异，以确定哪些因素可以归因于 在同一疗养院内区别对待病人，而不是对病人进行不同的分配 穿过疗养院。我们将分析替代公共政策对这些差距的可能影响，并 养老院居民的健康状况。我们的目标是阐明差距的来源和 不同类型的政策在缩小差距方面的潜力。

ABSTRACT The quality of nursing home care is an essential issue for the health and well-being of the elderly. For decades, there have been widespread concerns about the quality of nursing home care in the US, as well as disparities in the quality of care received across different groups. Exacerbating these issues are worries about the ability of patients (or their caregivers) to assess nursing home quality, an issue that is particularly acute for patients with Alzheimer’s disease or a related dementia (ADRD). We propose to document the extent of disparities in the quality of Medicare-covered nursing home care received, to investigate the forces behind those disparities, and to evaluate the impact of potential policy interventions. We will focus on disparities across racial groups (specifically Black non-Hispanic patients compared to White non-Hispanic patients), ethnic groups (Hispanic patients compared to non-Hispanic patients), socio-economic status (patients dually-enrolled in Medicaid at admission or not), and health groups (patients with and without ADRD on admission). To accomplish this, we will build on our existing work estimating average value-added for each nursing home. We created a measurement framework for estimating this value-added that can be applied to any health measure (or combination of health measures) in the rich data on patient physical health, mental health, daily functioning, dementia, and cognitive capacity available in the Centers for Medicare and Medicaid Services’ Minimum Data Set; these assessments cover all patients in Medicare and Medicaid certified nursing homes. We propose to expand our framework to allow value added to differ across different groups of patients within each nursing home, and then to use it to document the extent of disparities in nursing home quality experienced by group. Then we will examine the disparities in value-added to determine what can be attributed to differential treatment of patients within the same nursing home as opposed to different allocation of patients across nursing homes. We will analyze the likely impact of alternative public policies on these disparities and the health outcomes of nursing home residents. We aim to shed light on both the sources of disparities and the potential of different types of policies on reducing disparities.