Maine Rural Health Research Center, University of Southern Maine, Portland, Maine, US.
Muskie School of Public Service, University of Southern Maine, Portland, Maine, US.
Gerontologist. 2021 Aug 13;61(6):826-837. doi: 10.1093/geront/gnaa183.
Our primary objective was to assess rural-urban acuity differences among newly admitted older nursing home residents.
Data included the 2015 Minimum Data Set v3.0, the Area Health Resources File, the Provider of Services File, and Rural-Urban Commuting Area codes. Activities of daily living, the Cognitive Function Scale, and aggression/wandering indicators were used to assess functional, cognitive, and behavioral status, respectively. Excluding assessments for short stays (less than 90 days), assessments for 209,719 newly admitted long-stay residents aged 65 and older across 14,834 facilities in 47 states were evaluated. Difference in differences (DID) generalized linear models with state-fixed effects and clustering by facilities were used to assess the interaction effect of older age (75 plus) on rural-urban acuity differences, controlling for socioeconomic factors, admission source, and market characteristics.
Residents admitted to rural facilities were less functionally impaired (incidence rate ratio: 0.973-0.898) but had more cognitive (odds ratio [OR]: 1.03-1.22) and problem behaviors (OR: 1.19-1.48) than urban. Although older age was predictive of higher acuity, in DID models, the expected decline in functional status was comparable in rural and urban facilities, while the cognitive and behavioral status for older admissions was 8.0% and 8.5% lower in rural versus urban facilities, respectively.
Although the higher prevalence of cognitive impairment and problem behaviors among rural admissions was attributable in part to older age, rural facilities admitted less complex individuals among older age residents than urban facilities. Findings may reflect less capacity to manage older, complex individuals in rural facilities.
我们的主要目的是评估新入住的老年护理院居民的城乡医疗资源利用差异。
数据包括 2015 年最低数据集 v3.0、区域卫生资源文件、服务提供者文件和农村-城市通勤区代码。日常生活活动、认知功能量表和攻击/游荡指标分别用于评估功能、认知和行为状况。排除短期入住（少于 90 天）的评估后，对来自 47 个州的 14834 家机构的 209719 名 65 岁及以上的新入住长期居民进行了评估。使用具有州固定效应和按机构聚类的差异中的差异（DID）广义线性模型，控制社会经济因素、入院来源和市场特征，评估高龄（75 岁及以上）对城乡医疗资源利用差异的交互效应。
入住农村机构的居民功能障碍程度较低（发病率比：0.973-0.898），但认知（优势比 [OR]：1.03-1.22）和问题行为（OR：1.19-1.48）更多。尽管高龄是医疗资源利用程度高的预测因素，但在 DID 模型中，农村和城市机构的功能状态预期下降程度相当，而农村机构的高龄患者认知和行为状况分别比城市机构低 8.0%和 8.5%。
尽管农村入住患者认知障碍和行为问题的发生率较高部分归因于高龄，但农村机构对高龄居民的管理能力低于城市机构，入住的复杂性较低的个体较少。这些发现可能反映了农村机构在管理高龄、复杂患者方面的能力不足。
