Essentia Institute of Rural Health, Research Division, Duluth, MN 55805, USA.
J Am Med Dir Assoc. 2013 Aug;14(8):593-8. doi: 10.1016/j.jamda.2013.02.017. Epub 2013 Apr 9.
Advances in medicine and an aging US population suggest that there will be an increasing demand for nursing home services. Although nursing homes are highly regulated and scrutinized, their quality remains a concern and may be a greater issue to those living in rural communities. Despite this, few studies have investigated differences in the quality of nursing home care across the rural-urban continuum. The purpose of this study was to compare the quality of rural and nonrural nursing homes by using aggregated rankings on multiple quality measures calculated by the Centers for Medicare and Medicaid Services and reported on their Nursing Home Compare Web site.
Independent-sample t tests were performed to compare the mean ratings on the reported quality measures of rural and nonrural nursing homes. A linear mixed binary logistic regression model controlling for state was performed to determine if the covariates of ownership, number of beds, and geographic locale were associated with a higher overall quality rating.
Of the 15,177 nursing homes included in the study sample, 69.2% were located in nonrural areas and 30.8% in rural areas. The t test analysis comparing the overall, health inspection, staffing, and quality measure ratings of rural and nonrural nursing homes yielded statistically significant results for 3 measures, 2 of which (overall ratings and health inspections) favored rural nursing homes. Although a higher percentage of nursing homes (44.8%-42.2%) received a 4-star or higher rating, regression analysis using an overall rating of 4 stars or higher as the dependent variable revealed that when controlling for state and adjusting for size and ownership, rural nursing homes were less likely to have a 4-star or higher rating when compared with nonrural nursing homes (OR = .901, 95% CI 0.824-0.986).
Mixed model logistic regression analysis suggested that rural nursing home quality was not comparable to that of nonrural nursing homes. When controlling for state and adjusting for nursing home size and ownership, rural nursing homes were not as likely to earn a 4-or higher star quality rating as nonrural nursing homes.
医学的进步和美国人口老龄化表明，对养老院服务的需求将不断增加。尽管养老院受到高度监管和审查，但养老院的服务质量仍然令人担忧，对于居住在农村社区的人来说，这可能是一个更大的问题。尽管如此，很少有研究调查农村和城市地区养老院服务质量的差异。本研究的目的是通过使用医疗保险和医疗补助服务中心计算并在其养老院比较网站上报告的多项质量指标的综合排名来比较农村和非农村养老院的质量。
采用独立样本 t 检验比较报告的农村和非农村养老院质量指标的平均评分。采用线性混合二项逻辑回归模型，控制州别，以确定所有权、床位数和地理位置等协变量是否与整体质量评分较高相关。
在研究样本中，15177 家养老院中，69.2%位于非农村地区，30.8%位于农村地区。对农村和非农村养老院的整体、健康检查、人员配备和质量措施评分进行 t 检验分析，有 3 个指标的结果具有统计学意义，其中 2 个指标（整体评分和健康检查）有利于农村养老院。尽管有更高比例的养老院（44.8%-42.2%）获得 4 星或更高评级，但使用整体 4 星或更高评级作为因变量的回归分析显示，在控制州别并调整规模和所有权后，与非农村养老院相比，农村养老院获得 4 星或更高评级的可能性较小（OR=0.901，95%CI 0.824-0.986）。
混合模型逻辑回归分析表明，农村养老院的质量不如非农村养老院。在控制州别并调整养老院规模和所有权后，农村养老院获得 4 星或更高评级的可能性并不像非农村养老院那样高。
