Bolin Jane Nelson, Phillips Charles D, Hawes Catherine
Department of Health Policy and Management, School of Rural Public Health, The Texas A&M University System Health Sciences Center, College Station, TX 77843-1266, USA.
Gerontologist. 2006 Feb;46(1):33-41. doi: 10.1093/geront/46.1.33.
Previous research in specific locales indicates that individuals admitted to rural nursing homes have lower care needs than individuals admitted to nursing homes in urban areas, and that rural nursing homes differ in their mix of short-stay and chronic-care residents. This research investigates whether differences in acuity are a function of differences in resident payer status and occur for both individuals admitted for short stays, with Medicare as payer, and those needing chronic care.
We used a representative 10% sample of national resident assessments (Minimum Data Set) for calendar year 2000 (N = 197,589). We conducted statistical analyses (means, percentages, and logistic regression) to investigate differences in Medicare and non-Medicare admissions to facilities in metropolitan and nonmetropolitan areas.
Non-Medicare residents admitted to rural nursing facilities have lower acuity scores than non-Medicare residents admitted to metropolitan nursing homes. However, individuals admitted under Medicare were similar in rural and urban areas.
Differences in resident acuity at admission among facilities in different locales were largely a function of lower acuity levels for individuals admitted to rural nursing homes for long-term or chronic care, although differences in Medicare census also played some role in facility-level differences in acuity. Other factors must be explored to determine why this lower acuity occurs and whether higher use of rural nursing homes by less impaired older persons meets their needs and preferences and represents good public policy.
先前在特定地区的研究表明，入住农村疗养院的个体比入住城市疗养院的个体护理需求更低，且农村疗养院在短期居住和长期护理居民的构成上存在差异。本研究调查了护理需求差异是否是居民支付者身份差异的结果，以及这种差异是否同时存在于以医疗保险为支付者的短期入住个体和需要长期护理的个体中。
我们使用了2000年日历年全国居民评估（最低数据集）的10%代表性样本（N = 197,589）。我们进行了统计分析（均值、百分比和逻辑回归），以调查大城市和非大城市地区疗养院中医疗保险和非医疗保险入住情况的差异。
入住农村疗养院的非医疗保险居民的护理需求得分低于入住大城市疗养院的非医疗保险居民。然而，医疗保险覆盖下入住的个体在农村和城市地区情况相似。
不同地区疗养院入院时居民护理需求的差异，在很大程度上是由于入住农村疗养院接受长期或慢性护理的个体护理需求水平较低所致，尽管医疗保险人口普查的差异在疗养院层面的护理需求差异中也起到了一定作用。必须探索其他因素，以确定为何会出现这种较低的护理需求，以及身体状况较好的老年人更多地使用农村疗养院是否满足了他们的需求和偏好，是否代表了良好的公共政策。
