The urban-rural disparity in nursing home quality indicators: the case of facility-acquired contractures.
OBJECTIVE
To identify and quantify the sources of the urban-rural disparity in facility-acquired contracture rates in nursing homes.


METHODS
Survey inspection data of U.S. nursing homes from 1999 to 2008 and standardized national rural definition file from the Rural-Urban Commuting Area Codes.


METHODS
We estimated regressions of facility-level contracture rate as a function of urban-rural categories (urban, micropolitan, small rural town, and isolated small rural town) and other related facility characteristics to identify size of the urban-rural disparity. We used Blinder-Oaxaca decomposition techniques to determine the extent to which the disparity is attributable to the differences in facility and aggregate resident characteristics.


RESULTS
Rural nursing homes have higher contracture rates than urban nursing homes. About half of the urban-rural disparity is explained by differences in observable characteristics among urban and rural nursing homes. Differences in staffing levels explain less than 5 percent of the disparity, case-mix explains 6-8 percent, and structure and operational characteristics account for 10-22 percent of the disparity.


CONCLUSIONS
While a lower level and quality of staffing are a concern for rural nursing homes, facility structure and funding sources explain a larger proportion of the urban-rural disparity in the quality of care.
Department of Economics, Scripps Gerontology Center, Farmer School of Business, Miami University, 800 E. High Street, Oxford, OH 45056, USA. jbowblis@muohio.edu
John R
JR
Bowblis
Hongdao
H
Meng
Kathryn
K
Hyer
D003286:Contracture / Q000453:epidemiology*; D003953:Diagnosis-Related Groups; D054625:Healthcare Disparities / Q000458:organization & administration / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration* / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration / Q000706:statistics & numerical data; D015995:Prevalence; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States; D019037:Urban Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data