title: Trends in family ratings of experience with care and racial disparities among Maryland nursing homes.
abstract: BACKGROUND
  Providing equitable and patient-centered care is critical to ensuring high quality of care. Although racial/ethnic disparities in quality are widely reported for nursing facilities, it is unknown whether disparities exist in consumer experiences with care and how public reporting of consumer experiences affects facility performance and potential racial disparities.
  
  
  METHODS
  We analyzed trends of consumer ratings publicly reported for Maryland nursing homes during 2007-2010, and determined whether racial/ethnic disparities in experiences with care changed during this period. Multivariate longitudinal regression models controlled for important facility and county characteristics and tested changes overall and by facility groups (defined based on concentrations of black residents). Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights.
  
  
  RESULTS
  Overall ratings on care experience remained relatively high (mean=8.3 on a 1-10 scale) during 2007-2010. Ninety percent of survey respondents each year would recommend the facility to someone who needs nursing home care. Ratings on individual domains of care improved among all nursing homes in Maryland (P<0.01), except for food and meals (P=0.827 for trend). However, site-of-care disparities existed in each year for overall ratings, recommendation rate, and ratings on all domains of care (P<0.01 in all cases), with facilities more predominated by black residents having lower scores; such disparities persisted over time (P>0.2 for trends in disparities).
  
  
  CONCLUSIONS
  Although Maryland nursing homes showed maintained or improved consumer ratings during the first 4 years of public reporting, gaps persisted between facilities with high versus low concentrations of minority residents.
authors.affiliation: *Department of Public Health Sciences, Division of Health Policy and Outcomes Research †Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY.
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.forename: Zhiqiu
authors.initials: Z
authors.lastname: Ye
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.forename: Helena
authors.initials: H
authors.lastname: Temkin-Greener
mesh_terms: D003258:Consumer Behavior; D005190:Family / Q000523:psychology*; D005522:Food Services; D054625:Healthcare Disparities / Q000208:ethnology*; D006707:Homes for the Aged / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D008396:Maryland; D009735:Nursing Homes / Q000458:organization & administration / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000458:organization & administration; D026684:Personal Autonomy; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D044469:Racial Groups; D012111:Residence Characteristics