Effect of educational level and minority status on nursing home choice after hospital discharge.
OBJECTIVE
The movement to publicly report data on provider quality to inform consumer choices is predicated on assumptions of equal access and knowledge. We examine the validity of this assumption by testing whether minority/less educated Medicare patients are at greater risk of being discharged from a hospital to the lowest-quality nursing homes in a geographic area.


METHODS
We used the 2002 national Minimum Data Set to identify 62601 new Medicare admissions to nursing homes in 95 hospital service areas with at least 4 freestanding nursing homes and at least 50 African Americans aged 65 years or older with Medicare admissions to nursing homes.


RESULTS
The probability of African Americans' being admitted to nursing homes in the lowest-quality quartile in the area was greater (relative risk [RR]=1.26; 95% confidence interval [CI]=1.0, 8.45) in comparison with Whites. Individuals without a high-school degree were also more likely to be admitted to a low-quality nursing home (RR=1.22; 95% CI=1.0, 1.46).


CONCLUSIONS
African American and poorly educated patients enter the worst-quality nursing facilities. This finding raises concerns about the usefulness of the current public reporting model for certain consumers.
Angelelli
Joseph
J
The Pennsylvania State University, University Park, PA 1680-2500, USA. jangel@psu.edu
Grabowski
David C
DC
Mor
Vincent
V
D001741:Black or African American / Q000193:education* / Q000706:statistics & numerical data; D000359:Aftercare / Q000592:standards*; D000368:Aged; D000369:Aged, 80 and over; D002568:Certification; D004522:Educational Status; D005260:Female; D005843:Geography; D006801:Humans; D008297:Male; D006278:Medicare / Q000592:standards*; D008913:Minority Groups / Q000193:education* / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000592:standards* / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000145:classification*; D012306:Risk; D014481:United States; D044465:White People / Q000193:education / Q000706:statistics & numerical data