SEPARATE AND UNEQUAL

老年门诊、住院和长期医疗中的种族和民族差异 护理病人经常被记录在案。此外，疗养院的准入和护理质量 老年病人在养老院接受的护理，可以说是“分开的”(养老院倾向于 要么资金充裕，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”(较贫穷的家庭往往具有较低质量的护理过程和结果)。许多 据认为，造成这一令人遗憾的局面的因素包括居住隔离的模式、当地的长期 定期护理(LTC)市场结构、国家级报销政策、养老院(NH)级战略 决策，以及患者级别的特征，这些特征可能会影响将个人分类为特定类型 养老院的数量，取决于它们在不同社区的位置。这项研究将进行五项 具体目的是理清这些不同因素对保健服务获取和护理质量差异的影响。 我们将：1)根据患者住处(在此之前)构建可选的居住隔离措施 疗养院准入)；2)审查当地市场在进入疗养院方面的隔离模式 护理；3)探索不同隔离环境内和不同隔离环境之间的NH水平护理质量的差异； 4)开发和测试两个多水平模型，以解释整个NHS的护理质量水平的差异，以及 NHS内不同种族/民族经历的护理质量差异；以及5)探索两个 关于NH反应对护理和隔离的差异的影响的其他假设 护理设置。 世俗综述：贫困和少数群体更有可能在质量较差的护理中接受护理 家。这项研究试图找出解决不同养老院准入问题的可能解决方案 质量差异很大，并更好地定位LTC系统，为 老年人口将越来越多地非白人、女性、健康状况不佳和家庭有限 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.