*Department of Public Health Sciences, Division of Health Policy and Outcomes Research †Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY.
Med Care. 2014 Jul;52(7):641-8. doi: 10.1097/MLR.0000000000000152.
Providing equitable and patient-centered care is critical to ensuring high quality of care. Although racial/ethnic disparities in quality are widely reported for nursing facilities, it is unknown whether disparities exist in consumer experiences with care and how public reporting of consumer experiences affects facility performance and potential racial disparities.
We analyzed trends of consumer ratings publicly reported for Maryland nursing homes during 2007-2010, and determined whether racial/ethnic disparities in experiences with care changed during this period. Multivariate longitudinal regression models controlled for important facility and county characteristics and tested changes overall and by facility groups (defined based on concentrations of black residents). Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights.
Overall ratings on care experience remained relatively high (mean=8.3 on a 1-10 scale) during 2007-2010. Ninety percent of survey respondents each year would recommend the facility to someone who needs nursing home care. Ratings on individual domains of care improved among all nursing homes in Maryland (P<0.01), except for food and meals (P=0.827 for trend). However, site-of-care disparities existed in each year for overall ratings, recommendation rate, and ratings on all domains of care (P<0.01 in all cases), with facilities more predominated by black residents having lower scores; such disparities persisted over time (P>0.2 for trends in disparities).
Although Maryland nursing homes showed maintained or improved consumer ratings during the first 4 years of public reporting, gaps persisted between facilities with high versus low concentrations of minority residents.
提供公平和以患者为中心的护理对于确保高质量的护理至关重要。尽管在护理机构中广泛报道了种族/民族之间的护理质量差异，但尚不清楚在护理体验方面是否存在差异，以及消费者体验的公开报告如何影响机构绩效和潜在的种族差异。
我们分析了马里兰州护理院在 2007-2010 年期间公开报告的消费者评分趋势，并确定在此期间护理体验方面的种族/民族差异是否发生了变化。多变量纵向回归模型控制了重要的机构和县特征，并测试了整体变化以及根据黑人居民集中程度定义的机构群体的变化。消费者评分报告了：整体护理；机构推荐；员工绩效；护理提供；食物和膳食；物理环境；以及自主权和个人权利。
在 2007-2010 年期间，护理体验的总体评分仍然相对较高（1-10 分制的平均值为 8.3）。每年有 90%的调查受访者会向需要护理院护理的人推荐该机构。马里兰州所有护理院的护理各个领域的评分都有所提高（P<0.01），除了食物和膳食（趋势 P=0.827）。然而，在每年的护理体验总体评分、推荐率和所有护理领域的评分方面都存在场所护理差异（所有情况下 P<0.01），黑人居民占比较高的机构得分较低；这些差异随着时间的推移而持续存在（趋势差异 P>0.2）。
尽管在公开报告的前 4 年，马里兰州护理院的消费者评分保持或有所提高，但在高少数民族居民和低少数民族居民集中的机构之间仍然存在差距。
