Disparities in the Quality of Nursing Home Care

摘要 养老院护理质量是关乎老年人健康和福祉的重要问题。几十年来， 人们普遍担心美国疗养院护理的质量以及差异 不同群体所接受的护理质量。加剧这些问题的是对能力的担忧 患者（或其护理人员）评估疗养院质量，这个问题对患者来说尤其严重 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） 与非西班牙裔白人患者相比）、种族群体（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医疗补助的患者）以及健康群体 （入院时有或没有 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算每个疗养院的平均附加值。 我们创建了一个测量框架来估计这种附加值，可应用于任何健康状况 在有关患者身体健康、心理健康、日常情况的丰富数据中进行测量（或健康测量的组合） 医疗保险和医疗补助服务中心提供的功能、痴呆和认知能力 最小数据集；这些评估涵盖了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，以允许不同患者群体的附加价值有所不同 每个疗养院，然后用它来记录疗养院质量差异的程度 以团体经历。然后我们将检查增加值的差异，以确定可以归因于什么 对同一疗养院内的患者进行差别化治疗，而不是对患者进行不同的分配 穿过疗养院。我们将分析替代性公共政策对这些差异的可能影响，并 疗养院居民的健康结果。我们的目标是揭示差异的根源和 不同类型的政策在减少差距方面的潜力。

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.