Rivera-Hernandez Maricruz, Fabius Chanee D, Fashaw Shekinah, Downer Brian, Kumar Amit, Panagiotou Orestis A, Epstein-Lubow Gary
Department of Health, Services, Policy and Practice at the Brown University School of Public Health, Providence, RI, USA.
Bloomberg School of Public Health, Department of Health Policy and Management Johns Hopkins University, Baltimore, MD, USA.
J Am Med Dir Assoc. 2020 Nov;21(11):1705-1711.e3. doi: 10.1016/j.jamda.2020.06.030. Epub 2020 Jul 31.
As the number of Hispanics with dementia continues to increase, greater use of post-acute care in nursing home settings will be required. Little is known about the quality of skilled nursing facilities (SNFs) that disproportionately serve Hispanic patients with dementia and whether the quality of SNF care varies by the concentration of Medicare Advantage (MA) patients with dementia admitted to these SNFs.
Cross-sectional study using 2016 data from Medicare certified providers.
Our cohort included 177,396 beneficiaries with probable dementia from 8884 SNFs.
We examined facility-level quality of care among facilities with high and low proportions of Hispanic beneficiaries with probable dementia enrolled in MA and fee-for-service (FFS) using data from Medicare-certified providers. Three facility-level measures were used to assess quality of care: (1) 30-day rehospitalization rate; (2) successful discharge from the facility to the community; and (3) Medicare 5-star quality ratings.
About 20% of residents were admitted to 1615 facilities with a resident population that was more than 15% Hispanic. Facilities with a higher share of Hispanic residents had a lower proportion of 4- or 5-star facilities by an average of 14% to 15% compared with facilities with little to no Hispanics. In addition, these facilities had a 1% higher readmission rate. There were also some differences in the quality of facilities with high (>26.5%) and low (<26.5%) proportions of MA beneficiaries. On average, SNFs with a high concentration of MA patients have lower readmission rates and higher successful discharge, but lower star ratings.
Achieving better quality of care for people with dementia may require efforts to improve the quality of care among facilities with a high concentration of Hispanic residents.
随着患有痴呆症的西班牙裔人数持续增加，养老院环境中的急性后护理使用将需要增加。对于不成比例地服务于患有痴呆症的西班牙裔患者的专业护理机构（SNF）的质量以及SNF护理质量是否因入住这些SNF的医疗保险优势（MA）痴呆症患者的集中度而异，我们知之甚少。
使用来自医疗保险认证提供者的2016年数据进行横断面研究。
我们的队列包括来自8884个SNF的177396名可能患有痴呆症的受益人。
我们使用来自医疗保险认证提供者的数据，研究了在MA和按服务收费（FFS）中登记的可能患有痴呆症的西班牙裔受益人的比例高低不同的机构中机构层面的护理质量。使用三项机构层面的指标来评估护理质量：（1）30天再住院率；（2）从机构成功出院到社区；（3）医疗保险五星级质量评级。
约20%的居民入住了1615家机构，这些机构的居民中有超过15%是西班牙裔。与几乎没有或没有西班牙裔居民的机构相比，西班牙裔居民比例较高的机构中，四星级或五星级机构的比例平均低14%至15%。此外，这些机构的再入院率高1%。MA受益人的比例高（>26.5%）和低（<26.5%）的机构在质量上也存在一些差异。平均而言，MA患者集中度高的SNF再入院率较低，成功出院率较高，但星级评级较低。
要为痴呆症患者实现更好的护理质量，可能需要努力提高西班牙裔居民集中度高的机构的护理质量。
