美国养老院护理服务的供应和质量在地域上长期存在差异：1996 年至 2016 年。
Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016.
机构信息
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT, 06510, USA.
出版信息
BMC Geriatr. 2019 Apr 11;19(1):103. doi: 10.1186/s12877-019-1117-z.
BACKGROUND
Availability of nursing home care has declined and national efforts have been initiated to improve the quality of nursing home care in the U.S. Yet, data are limited on whether there are geographic variations in declines of availability and quality of nursing home care, and whether variations persist over time. We sought to assess geographic variation in availability and quality of nursing home care.
METHODS
Retrospective study using Medicaid/Medicare-certified nursing home data from the Centers for Medicare & Medicaid Services, 1996-2016. Outcomes were 1) availability of all nursing home care (1996-2016), measured by the number of Medicaid/Medicare-certified beds for a given county per 100,000 population aged ≥65 years, regardless of nursing home star rating; 2) availability of 5-star nursing home care, measured by the number of Medicaid/Medicare-certified beds provided by 5-star nursing homes; and 3) utilization of nursing home beds, defined as the rate of occupied Medicaid/Medicare-certified beds among the total Medicaid/Medicare-certified beds.
RESULTS
From 1999 to 2016, availability of all nursing home care declined from 4882 (standard deviation: 931) to 3480 (912) beds, per 100,000 population aged ≥65 years. Persistent geographic variation in availability of nursing home care was observed; the correlation coefficient of county-specific availabilities from 1996 to 2016 was 0.78 (95% CI 0.77-0.79). From 2011 to 2016, availability of 5-star nursing home beds increased from 658 (303) to 895 (661) per 100,000 population aged ≥65 years. The correlation coefficient for county-specific availabilities from 2011 to 2016 was 0.54 (95% CI 0.51-0.56). Availability and quality of nursing home care were not highly correlated. In 2016, the correlation coefficient for county-specific availabilities between all nursing home and 5-star nursing home beds was 0.33 (95% CI 0.30-0.36). From 1996 to 2016, the utilization of certified beds declined from 78.5 to 72.2%. This decline was consistent across all census divisions, but most pronounced in the Mountain division and less in the South-Atlantic division.
CONCLUSION
We observed persistent geographic variations in availability and quality of nursing home care. Availability of all nursing home care declined but availability of 5-star nursing home care increased. Availability and quality of nursing home care were not highly correlated.
背景
美国养老院的护理能力有所下降，为此，国家已着手努力提高养老院的护理质量。然而，关于养老院护理能力和质量的下降是否存在地域差异，以及这种差异是否持续存在，相关数据十分有限。我们旨在评估养老院护理能力和质量的地域差异。
方法
本研究使用了医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）的养老院数据，这是一项回顾性研究，时间范围为 1996 年至 2016 年。结果有：1）养老院护理能力的整体可用性（1996-2016 年），通过每 10 万 65 岁以上人口的养老院护理床位数量（无论养老院星级如何）来衡量；2）5 星级养老院护理能力的可用性，通过 5 星级养老院提供的养老院护理床位数量来衡量；3）养老院床位的利用率，定义为养老院护理床位总数中已占用的养老院护理床位的比例。
结果
从 1999 年至 2016 年，每 10 万 65 岁以上人口的养老院护理床位数量从 4882（标准差：931）下降至 3480（912）张。观察到养老院护理能力的地域差异持续存在；1996 年至 2016 年，县特定供应的相关系数为 0.78（95%CI 0.77-0.79）。从 2011 年至 2016 年，每 10 万 65 岁以上人口的 5 星级养老院床位数量从 658（303）张增加至 895（661）张。2011 年至 2016 年，县特定供应的相关系数为 0.54（95%CI 0.51-0.56）。养老院护理能力和质量的供应并没有高度相关。2016 年，所有养老院和 5 星级养老院床位的县特定供应相关系数为 0.33（95%CI 0.30-0.36）。从 1996 年至 2016 年，认证床位的利用率从 78.5%下降至 72.2%。这种下降在所有普查分区都存在，但在山区分区最为明显，在大西洋南部分区则不那么明显。
结论
我们观察到养老院护理能力和质量的持续地域差异。养老院护理能力的整体可用性下降，但 5 星级养老院护理能力的可用性增加。养老院护理能力和质量的供应并没有高度相关。
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