Deficiencies In Care At Nursing Homes And Racial/Ethnic Disparities Across Homes Fell, 2006-11
Deficiencies In Care At Nursing Homes And Racial/Ethnic Disparities Across Homes Fell, 2006-11
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DOI：
10.1377/hlthaff.2015.0094
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发表时间：
2015-07-01
期刊：
影响因子：
9.7
通讯作者：
Mukamel, Dana B.
中科院分区：
文献类型：
--
作者：
Li, Yue;Harrington, Charlene;Mukamel, Dana B.
尽管少数民族居民越来越多地使用养老院，但养老院的护理仍然高度隔离。与白人相比，少数种族/族裔往往在有限的临床和财政资源、低护士人员水平和相对较高的护理不足引用的设施中得到照顾。我们评估了从2006年到2011年这些引用的趋势以及四种不同种族/少数民族居民集中的设施之间的差异。我们发现，随着时间的推移，所有四个设施组的卫生保健相关缺陷的数量和严重缺陷的设施的百分比都在减少。从2006年到2011年，在少数民族集中程度较低（= 35%）的设施中，与保健有关的缺陷的年平均数量从7.4例下降到6.8例。在多变量分析中，卫生保健相关缺陷和生命安全缺陷的跨站点差异随着时间的推移而缩小。我们还发现，提高医疗补助支付率可能有助于改善整体质量和差距，但州病例混合支付方法可能会使两者恶化。这些结果表明，需要重新评估质量改进和成本控制的努力，以更好地促进养老院护理的质量和公平。
Despite the increased use of nursing homes by minority residents, nursing home care remains highly segregated. Compared to whites, racial/ethnic minorities tend to be cared for in facilities with limited clinical and financial resources, low nurse staffing levels, and a relatively high number of care deficiency citations. We assessed the trends from 2006 to 2011 in those citations and in disparities across facilities with four different concentrations of racial/ethnic minority residents. We found that the number of health care-related deficiencies and the percentage of facilities with serious deficiencies decreased over time for all four facility groups. From 2006 to 2011 the average annual number of health care-related deficiencies declined from 7.4 to 6.8 for facilities with low minority concentrations (= 35 percent). In multivariable analyses, across-site disparities in health care-related deficiencies and in life-safety deficiencies narrowed over time. We also found that increasing the Medicaid payment rate might help improve both overall quality and disparities, but state case-mix payment approaches might worsen both. These results suggest the need to reevaluate quality improvement and cost containment efforts to better foster the quality and equity of nursing home care.