Disparities in the Quality of Nursing Home Care

摘要 养老院护理的质量是老年人健康和福祉的重要问题。几十年来， 人们普遍担心美国养老院护理的质量， 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 病人（或他们的照顾者）评估疗养院的质量，一个问题，这是特别严重的病人 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疗养院护理质量的差异程度 调查这些差异背后的力量，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群体之间的差异（特别是黑人非西班牙裔患者 与白色非西班牙裔患者相比）、种族组（西班牙裔患者与非西班牙裔患者相比 患者）、社会经济状况（入院时是否双重参加Medicaid的患者）和健康组 （入院时有和无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养老院的平均附加值。 我们创建了一个衡量框架，用于估计这种附加值，可以应用于任何健康 测量（或健康测量的组合）在关于患者身体健康、心理健康、每日 功能，痴呆症和认知能力，可在医疗保险和医疗补助服务中心， 最小数据集;这些评估涵盖了医疗保险和医疗补助认证的疗养院的所有患者。 我们建议扩大我们的框架，使不同的患者群体之间的增值有所不同， 每个养老院，然后用它来记录养老院质量的差异程度 经历过群体。然后，我们将研究增加值的差异，以确定可以归因于什么 在同一家疗养院内对病人进行区别对待，而不是对病人进行不同的分配 在养老院里我们将分析替代公共政策对这些差异的可能影响， 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.