社区新入住的 ADRD 患者的养老院护理质量：种族重要吗？
Quality of Nursing Homes Among ADRD Residents Newly Admitted From the Community: Does Race Matter?
机构信息
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
出版信息
J Am Med Dir Assoc. 2023 May;24(5):712-717. doi: 10.1016/j.jamda.2023.01.017. Epub 2023 Mar 1.
OBJECTIVE
To examine racial differences in admissions to high-quality nursing homes (NHs) among residents with Alzheimer disease and related dementias (ADRD), and whether such racial differences can be influenced by dementia-related state Medicaid add-on policies.
DESIGN
Retrospective cross-sectional study.
SETTING AND PARTICIPANTS
The study included 786,096 Medicare beneficiaries with ADRD newly admitted from the community to NHs between January 1, 2011 and December 31, 2017.
METHODS
2010-2017 Minimum Data Set 3.0, Medicare Beneficiary Summary File, Medicare Provider Analysis and Review, and Nursing Home Compare data were linked. For each individual, we constructed a "choice" set of NHs based on the distance between the NH and an individual residential zip code. McFadden's choice models were estimated to examine the relationship between admission into a high-quality (4- or 5-star) NH and individual characteristics, specifically race, and state Medicaid dementia-related add-on policies.
RESULTS
Among the identified residents, 89% were White, and 11% were Black. Overall, 50% of White and 35% of Black individuals were admitted to high-quality NHs. Black individuals were more likely to be Medicare-Medicaid dually eligible. Results from McFadden's model suggested that Black individuals were less likely to be admitted to a high-quality NH than White individuals (OR = 0.615, P < .01), and such differences were partially explained by some individual characteristics. Furthermore, we found that the racial difference was reduced in states with dementia-related add-on policies, compared with states without these policies (OR = 1.16, P < .01).
CONCLUSIONS AND IMPLICATIONS
Black individuals with ADRD were less likely to be admitted to high-quality NHs than White individuals. Such difference was partially related to individuals' health conditions, social-economic status, and state Medicaid add-on policies. Policies to reduce barriers to high-quality NHs among Black individuals are necessary to mitigate health inequity in this vulnerable population.
目的
考察在患有阿尔茨海默病和相关痴呆症（ADRD）的居民中，进入高质量养老院（NHs）的种族差异，以及这种种族差异是否会受到与痴呆症相关的州 Medicaid 附加政策的影响。
设计
回顾性的横截面研究。
地点和参与者
该研究包括 2011 年 1 月 1 日至 2017 年 12 月 31 日期间，从社区新进入 NH 的 786096 名 Medicare 受益人患有 ADRD。
方法
2010-2017 年最小数据集 3.0、医疗保险受益人摘要文件、医疗保险提供者分析和审查以及疗养院比较数据进行了关联。对于每个人，我们根据 NH 与个人居住邮政编码之间的距离构建了 NH 的“选择”集。使用麦克法登选择模型来考察进入高质量（4 或 5 星级）NH 与个人特征（特别是种族）以及州 Medicaid 与痴呆症相关的附加政策之间的关系。
结果
在所确定的居民中，89%为白人，11%为黑人。总体而言，50%的白人患者和 35%的黑人患者被收治到高质量 NH 中。黑人患者更有可能同时享受 Medicare-Medicaid 双重保险。麦克法登模型的结果表明，与白人患者相比，黑人患者被收治到高质量 NH 的可能性较低（OR=0.615，P<.01），而且这种差异部分可以通过一些个体特征来解释。此外，我们发现与没有这些政策的州相比，在有与痴呆症相关的附加政策的州，这种种族差异有所缩小（OR=1.16，P<.01）。
结论和意义
患有 ADRD 的黑人患者被收治到高质量 NH 的可能性低于白人患者。这种差异部分与个体的健康状况、社会经济地位和州 Medicaid 附加政策有关。需要制定政策来减少黑人患者进入高质量 NH 的障碍，以减轻这一弱势群体的健康不平等。
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