Shippee Tetyana P, Davila Heather, Ng Weiwen, Bowblis John R, Akosionu Odichinma, Skarphol Tricia, See Thao Mai, Woodhouse Mark, Thorpe Roland J
Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa, USA.
Innov Aging. 2022 May 23;6(4):igac037. doi: 10.1093/geroni/igac037. eCollection 2022.
Abundant evidence documents racial/ethnic disparities in access, quality of care, and quality of life (QoL) among nursing home (NH) residents who are Black, Indigenous, and people of color (BIPOC) compared with White residents. BIPOC residents are more likely to be admitted to lower quality NHs and to experience worse outcomes. Yet, little is known about processes for differences in QoL among residents receiving care in high-proportion BIPOC NHs. This study presents an examination of the processes for racial/ethnic disparities in QoL in high-proportion BIPOC facilities while highlighting variability in QoL between these facilities.
Guided by the Minority Health and Health Disparities Research Framework and the Zubritsky framework for QoL in NHs, we employ a concurrent mixed-methods approach involving in-depth case studies of 6 high-proportion BIPOC NHs in Minnesota (96 resident interviews; 61 staff interviews; 614 hours of observation), coupled with statewide survey data on residents' QoL linked to resident clinical Minimum Data Set assessments.
Quantitative findings show that BIPOC residents experience lower QoL than White residents across various domains. Qualitative findings reveal variability in BIPOC residents' QoL between high-proportion BIPOC facilities. In some facilities, BIPOC residents experienced worse QoL based on their race/ethnicity, whereas in others BIPOC residents QoL was not directly affected by their race/ethnicity or they had mixed experiences.
The findings highlight variability in racial/ethnic disparities in QoL across NHs with a high proportion of BIPOC residents. We identify health equity initiatives, including engaging with community BIPOC organizations and volunteers, and providing more resources to high-proportion BIPOC facilities to support staff training, additional staffing, and culturally specific programming. Given the increasing racial/ethnic diversity of NHs, ensuring equity in QoL for BIPOC residents is an urgent priority for NHs to remain relevant in the future.
大量证据表明，与白人居民相比，养老院中黑人、原住民及有色人种（BIPOC）居民在医疗服务可及性、护理质量和生活质量（QoL）方面存在种族/民族差异。BIPOC居民更有可能入住质量较低的养老院，且预后更差。然而，对于在BIPOC居民比例较高的养老院中接受护理的居民，其生活质量差异的过程却知之甚少。本研究对BIPOC居民比例较高的养老院中生活质量的种族/民族差异过程进行了考察，同时突出了这些养老院之间生活质量的差异。
以少数族裔健康与健康差异研究框架以及养老院生活质量的祖布里茨基框架为指导，我们采用了一种并行混合方法，包括对明尼苏达州6家BIPOC居民比例较高的养老院进行深入案例研究（96次居民访谈；61次工作人员访谈；614小时观察），并结合与居民临床最小数据集评估相关的全州居民生活质量调查数据。
定量研究结果表明，在各个领域，BIPOC居民的生活质量均低于白人居民。定性研究结果揭示了BIPOC居民比例较高的养老院之间生活质量的差异。在一些养老院中，BIPOC居民因其种族/民族而经历了更差的生活质量，而在其他养老院中，BIPOC居民的生活质量并未直接受到其种族/民族的影响，或者他们有不同的经历。
研究结果突出了BIPOC居民比例较高的养老院中生活质量的种族/民族差异。我们确定了促进健康公平的举措，包括与社区BIPOC组织和志愿者合作，以及向BIPOC居民比例较高的养老院提供更多资源，以支持员工培训、增加人员配备和开展具有文化特色的项目。鉴于养老院中种族/民族多样性的增加，确保BIPOC居民的生活质量公平是养老院未来保持相关性的当务之急。
