SEPARATE AND UNEQUAL

老年人门诊、住院和长期医疗中的种族和民族差异 护理患者经常被记录。此外，无论是进入养老院的机会，还是 养老院老年患者接受的护理可以被描述为“单独的”（养老院往往 要么资金充足，位于资源丰富的地区，要么设备简陋，位于贫困地区。 社区）和“不平等”（较贫穷的家庭往往有较低质量的护理过程和结果）。许多 人们认为，造成这种令人遗憾的局面的因素包括居住隔离的模式、当地长期 长期护理（LTC）市场结构，州一级报销政策，疗养院（NH）级战略 决定，以及患者水平的特征，这些特征可以影响将个体分类为特定类型 养老院，取决于他们在不同社区的位置。本研究将探讨五个 具体的目的是解开这些不同的因素对NH访问和护理质量差异的影响。 我们将：1）根据病人的居住地（在 进入疗养院）; 2）研究当地市场在进入疗养院方面的隔离模式 3）探讨不同隔离背景下和不同隔离背景下NH级护理质量的差异; 4)开发和测试两个多层次模型，以解释不同国家卫生机构之间护理质量水平的差异，以及 不同种族/民族群体在NHS中所经历的护理质量差异;以及5）探索两个 关于NH反应对护理和隔离差异的影响的其他假设 护理设置。 简单总结：穷人和少数民族更有可能接受质量较差的护理 木屋.本研究旨在确定可能的解决方案，以解决护理院的差异问题 的质量差异很大，并更好地定位LTC系统，以提供平等和适当的照顾， 老年人口将越来越多的非白人，女性，健康状况不佳，家庭成员有限 援助.

Racial and ethnic disparities in the medical treatment of elderly ambulatory, hospitalized and long term care patients have been frequently documented. In addition, both access to nursing homes and the quality of care received by elderly patients in nursing homes, can be described as "separate" (nursing homes tend to be either well financed and located in resource-rich areas, or poorly equipped and located in poor communities) and "unequal" (poorer homes tend to have lower quality care processes and outcomes). Many factors are thought to contribute to this sorry picture, including patterns of residential segregation, local long term care (LTC) market structure, state level reimbursement policies, nursing home (NH)-level strategic decisions, and patient level characteristics which can influence the sorting of individuals into particular types of nursing homes, depending upon their location in different neighborhoods. This study will pursue five specific aims to untangle the effects of these various factors on NH access and quality of care differences. We will: 1) construct alternative measures of residential segregation based on patient residence (prior to nursing home entry); 2) examine patterns of segregation within local markets in access to nursing home care; 3) explore differences in NH-level quality of care within and between different segregation contexts; 4)develop and test two multi-level models to explain variation in quality of care levels across NHs, and differences in quality of care experienced by different racial/ethnic groups within NHs; and 5) explore two additional hypotheses concerning the implications of NH responses for disparities in care and segregated care settings. Lay Summary: Persons who are poor and minority are more likely to receive care in poorer quality nursing homes. This study seeks to identify possible solutions to the problem of differential access to nursing homes of vastly different quality, and to better position the LTC system to provide equal and appropriate care to an elderly population that will be increasingly nonwhite, female, in poor health, and with limited family assistance.