title: Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey.
abstract: OBJECTIVE
  To evaluate the impact of rural geographic location on nursing home quality of care in the United States.
  
  
  METHODS
  The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics.
  
  
  RESULTS
  Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident.
  
  
  CONCLUSIONS
  Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.
authors: Department of Public Health and Health Sciences, University of Michigan-Flint, 2102 W.S. White Building, 303 East Kearsley Street, Flint, MI 48502-1950, USA. yukang@umich.edu
authors: Yu
authors: Y
authors: Kang
authors: Hongdao
authors: H
authors: Meng
authors: Nancy A
authors: NA
authors: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D017589:Immunization Programs; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control*; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes / Q000592:standards*; D010147:Pain Measurement; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000276:immunology*; D011787:Quality of Health Care; D019035:Rural Health Services / Q000592:standards*; D012424:Rural Population; D014481:United States / Q000453:epidemiology
chemical_list: D022242:Pneumococcal Vaccines