Environmental and structural factors driving poor quality of care: An examination of nursing homes serving Black residents.
J Am Geriatr Soc
; 71(10): 3040-3048, 2023 10.
Article
em En
| MEDLINE
| ID: mdl-37306117
ABSTRACT
BACKGROUND:
Poor quality of care in nursing homes (NHs) with high proportions of Black residents has been a problem in the US and even more pronounced during the COVID-19 pandemic. Federal and state agencies are devoting attention to identifying the best means of improving care in the neediest facilities. It is important to understand environmental and structural characteristics that may have led to poor healthcare outcomes in NHs serving high proportions of Black residents pre-pandemic.METHODS:
We conducted a cross-sectional observational study using multiple 2019 national datasets. Our exposure was the proportion of Black residents in a NH (i.e., none, <5%, 5%-19.9%, 20-49.9%, ≥50%). Healthcare outcomes examined were hospitalizations and emergency department (ED) visits, both observed and risk-adjusted. Structural factors included staffing, ownership status, bed count (0-49, 50-149, or ≥150), chain organization membership, occupancy, and percent Medicaid as a payment source. Environmental factors included region and urbanicity. Descriptive and multivariable linear regression models were estimated.RESULTS:
In the 14,121 NHs, compared to NHs with no Black residents, NHs with ≥50% Black residents tended to be urban, for-profit, located in the South, have more Medicaid-funded residents, and have lower ratios of registered-nurse (RN) and aide hours per resident per day (HPRD) and greater ratios of licensed practical nurse HPRD. In general, as the proportion of Black residents in a NH increased, hospitalizations and ED visits also increased. DISCUSSION/IMPLICATIONS As lower use of RNs has been associated with increased ED visits and hospitalizations in NHs generally, it is likely low RN use largely drove the differences in hospitalizations and ED visits in NHs with greater proportions of Black residents. Staffing is an area in which state and federal agencies should take action to improve the quality of care in NHs with larger proportions of Black residents.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pandemias
/
COVID-19
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Aspecto:
Equity_inequality
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Am Geriatr Soc
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Estados Unidos