McGregor Margaret J, Cohen Marcy, Stocks-Rankin Catherine-Rose, Cox Michelle B, Salomons Kia, McGrail Kimberlyn M, Spencer Charmaine, Ronald Lisa A, Schulzer Michael
Department of Family Practice, University of British Columbia, Room 713, 828 West 10th Avenue,Vancouver, BC V5Z 1L8, Canada.
Open Med. 2011;5(4):e183-92. Epub 2011 Nov 15.
Nursing homes provide long-term housing, support and nursing care to frail elders who are no longer able to function independently. Although studies conducted in the United States have demonstrated an association between for-profit ownership and inferior quality, relatively few Canadian studies have made performance comparisons with reference to type of ownership. Complaints are one proxy measure of performance in the nursing home setting. Our study goal was to determine whether there is an association between facility ownership and the frequency of nursing home complaints.
We analyzed publicly available data on complaints, regulatory measures, facility ownership and size for 604 facilities in Ontario over 1 year (2007/08) and 62 facilities in British Columbia (Fraser Health region) over 4 years (2004-2008). All analyses were carried out at the facility level. Negative binomial regression analysis was used to assess the association between type of facility ownership and frequency of complaints.
The mean (standard deviation) number of verified/substantiated complaints per 100 beds per year in Ontario and Fraser Health was 0.45 (1.10) and 0.78 (1.63) respectively. Most complaints related to resident care. Complaints were more frequent in facilities with more citations, i.e., violations of the legislation or regulations governing a home, (Ontario) and inspection violations (Fraser Health). Compared with Ontario's for-profit chain facilities, adjusted incident rate ratios and 95% confidence intervals of verified complaints were 0.56 (0.27-1.16), 0.58 (0.34-1.00), 0.43 (0.21- 0.88), and 0.50 (0.30- 0.84) for for-profit single-site, non-profit, charitable, and public facilities respectively. In Fraser Health, the adjusted incident rate ratio of substantiated complaints in non-profit facilities compared with for-profit facilities was 0.18 (0.07-0.45).
Compared with for-profit chain facilities, non-profit, charitable and public facilities had significantly lower rates of complaints in Ontario. Likewise, in British Columbia's Fraser Health region, non-profit owned facilities had significantly lower rates of complaints compared with for-profit owned facilities.
养老院为无法独立生活的体弱老年人提供长期居住、支持及护理服务。尽管在美国进行的研究已表明营利性所有权与质量较差之间存在关联，但相对较少的加拿大研究对不同所有权类型的表现进行过比较。投诉是养老院环境中表现的一种代理指标。我们的研究目标是确定养老院所有权与投诉频率之间是否存在关联。
我们分析了安大略省604家养老院在1年（2007/08年）期间以及不列颠哥伦比亚省（菲沙卫生区）62家养老院在4年（2004 - 2008年）期间关于投诉、监管措施、养老院所有权及规模的公开数据。所有分析均在机构层面进行。采用负二项回归分析来评估养老院所有权类型与投诉频率之间的关联。
安大略省和菲沙卫生区每100张床位每年经核实/证实的投诉平均（标准差）数量分别为0.45（1.10）和0.78（1.63）。大多数投诉与居民护理有关。在违规次数更多的机构中投诉更频繁，即违反养老院相关法律法规（安大略省）以及检查违规（菲沙卫生区）。与安大略省的营利性连锁机构相比，营利性单址、非营利、慈善及公立机构经核实投诉的调整发病率比及95%置信区间分别为0.56（0.27 - 1.16）、0.58（0.34 - 1.00）、0.43（0.21 - 0.88）和0.50（0.30 - 0.84）。在菲沙卫生区，非营利机构与营利性机构相比，经证实投诉的调整发病率比为0.18（0.07 - 0.45）。
与营利性连锁机构相比，安大略省的非营利、慈善及公立机构投诉率显著更低。同样，在不列颠哥伦比亚省的菲沙卫生区，非营利机构与营利性机构相比投诉率显著更低。
