Center for Gerontology and Health Care Research, The Warren Alpert Medical School, Brown University, 121 South Main Street, Providence, RI 02912, USA.
Med Care. 2010 Mar;48(3):233-9. doi: 10.1097/MLR.0b013e3181ca2810.
The occurrence of pressure ulcers (PUs) in nursing homes is a marker for poor quality of care. We examine whether differences in PU prevalence between black and white residents are due to within- or across-facility disparities.
Minimum Data Sets (2006-2007) are linked with the Online Survey Certification and Reporting database. Long-term care residents with high risk for PUs are identified. The dependent variable is dichotomous, indicating PU presence/absence. Individual race and facility race-mix are the main variables of interests.The sample includes 59,740 long-term care high-risk residents (17.4% black and 82.6% white) in 619 nursing homes. We fit 3 risk-adjusted logit models: base, conditional fixed-effects, and random-effects.
Unadjusted PU prevalence is 14.5% (18.2% for blacks and 13.8% for whites). Overall, blacks are more likely to have PUs than whites, controlling for individual risk factors. We find no such effect within facilities after additional accounting for facility fixed effects. The effect of race is significantly different between the base and the conditional fixed-effects logit model. The random-effects and conditional fixed-effects logit models show similar results, demonstrating that higher PU presence among blacks is associated with greater facility-specific concentration of black residents.
Greater PU occurrence among blacks may not result from differential within-facility treatment of blacks versus whites. Rather, blacks are more likely to reside in facilities with poorer care quality. To improve PU care for blacks, efforts should focus on improving the overall quality of care for facilities with high proportion of black residents.
养老院中压疮（PU）的发生是护理质量差的标志。我们研究黑人居民和白人居民之间的 PU 患病率差异是由于设施内还是跨设施的差异。
将最低数据集（2006-2007 年）与在线调查认证和报告数据库相关联。确定有 PU 高风险的长期护理居民。因变量为二分变量，表示存在/不存在 PU。个人种族和设施种族混合是主要关注的变量。该样本包括 619 家养老院的 59740 名长期护理高危居民（17.4%为黑人，82.6%为白人）。我们拟合了 3 个风险调整后的逻辑回归模型：基础模型、条件固定效应模型和随机效应模型。
未经调整的 PU 患病率为 14.5%（黑人患病率为 18.2%，白人患病率为 13.8%）。总体而言，黑人患 PU 的可能性高于白人，控制了个体风险因素。在进一步考虑了设施固定效应后，我们没有发现设施内的这种影响。在基础模型和条件固定效应逻辑回归模型中，种族的影响存在显著差异。随机效应和条件固定效应逻辑回归模型得出了相似的结果，表明黑人中更高的 PU 患病率与设施内黑人居民的集中程度更高有关。
黑人中更高的 PU 发生率可能不是由于对黑人与白人的设施内治疗存在差异所致。相反，黑人更有可能居住在护理质量较差的设施中。为了改善黑人的 PU 护理，应努力提高高比例黑人居民设施的整体护理质量。
