title: Deficiencies In Care At Nursing Homes And Racial/Ethnic Disparities Across Homes Fell, 2006-11.
abstract: Despite the increased use of nursing homes by minority residents, nursing home care remains highly segregated. Compared to whites, racial/ethnic minorities tend to be cared for in facilities with limited clinical and financial resources, low nurse staffing levels, and a relatively high number of care deficiency citations. We assessed the trends from 2006 to 2011 in those citations and in disparities across facilities with four different concentrations of racial/ethnic minority residents. We found that the number of health care-related deficiencies and the percentage of facilities with serious deficiencies decreased over time for all four facility groups. From 2006 to 2011 the average annual number of health care-related deficiencies declined from 7.4 to 6.8 for facilities with low minority concentrations (<5 percent) and from 10.6 to 9.4 for facilities with high minority concentrations (≥35 percent). In multivariable analyses, across-site disparities in health care-related deficiencies and in life-safety deficiencies narrowed over time. We also found that increasing the Medicaid payment rate might help improve both overall quality and disparities, but state case-mix payment approaches might worsen both. These results suggest the need to reevaluate quality improvement and cost containment efforts to better foster the quality and equity of nursing home care.
authors.affiliation: Yue Li (yue_li@urmc.rochester.edu) is an associate professor in the Department of Public Health Sciences at the University of Rochester Medical Center, in New York.
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.affiliation: Charlene Harrington is a professor of nursing at the University of California, San Francisco.
authors.forename: Charlene
authors.initials: C
authors.lastname: Harrington
authors.affiliation: Helena Temkin-Greener is a professor in the Department of Public Health Sciences at the University of Rochester Medical Center.
authors.forename: Helena
authors.initials: H
authors.lastname: Temkin-Greener
authors.affiliation: Kai You is a PhD candidate in public health sciences at the University of Rochester.
authors.forename: Kai
authors.initials: K
authors.lastname: You
authors.affiliation: Xueya Cai is a research assistant professor of biostatistics and computational biology at the University of Rochester.
authors.forename: Xueya
authors.initials: X
authors.lastname: Cai
authors.affiliation: Xi Cen is a PhD candidate in public health sciences at the University of Rochester.
authors.forename: Xi
authors.initials: X
authors.lastname: Cen
authors.affiliation: Dana B. Mukamel is a professor in the Department of Medicine at the University of California, Irvine.
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D003953:Diagnosis-Related Groups / Q000191:economics; D005006:Ethnicity / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008484:Medicaid / Q000191:economics* / Q000458:organization & administration; D008913:Minority Groups / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000191:economics / Q000592:standards*; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care; D044469:Racial Groups; D014481:United States
keywords: Disparities; Long-Term Care; Quality Of Care